As the cost of basic necessities like food and housing rise, many Americans are finding it more challenging to afford their prescriptions. About 25% of adults say they or a family member have not filled a prescription, cut pills in half, or skipped doses in the last year because of cost, according to recent polling. In 2019, nearly 1.5 million patients with Medicare Part D, a voluntary outpatient prescription drug benefit, paid annual out-of-pocket costs so burdensome that they passed the program’s catastrophic threshold—up from 380,000 patients in 2010.
For those who need high-cost specialty medications and infusion treatments, the challenge may seem insurmountable. The average specialty drug price reached $84,442 in 2020, rising more than three times faster than the general inflation rate. And staff at pharmacies and infusion centers—who are already dealing with record burnout levels—are feeling the pinch as well.
High Costs Force Patients to Give Up Treatment
The skyrocketing costs of specialty medications mean many patients are left scrambling to pay for the treatment they need. Those who can’t afford their medications may feel they have no choice but to go without.
“Nobody budgets for catastrophic illnesses,” says TailorMed Financial Navigator Denise Chan, who previously worked as a specialty pharmacy technician. “When I would counsel patients, the costs of specialty medications were staggering, even for those who were financially secure.”
Out-of-pocket costs for specialty medications and infusion therapies are so significant that many seriously ill patients never fill their prescriptions—or discontinue therapy altogether. Specialty therapies are abandoned more frequently than any other type of medication during a patient’s health plan deductible period. And even after patients meet their deductible, their out-of-pocket responsibility may still render medications unaffordable. “If a 30-day supply of a medication is $12,000 and the patient’s coinsurance is 5%, they’d still have to pay $600,” Chan explains. It’s not surprising that 18% of patients abandon their prescribed therapy for diabetes, anticoagulants, and cancer drugs due to costs.
These abandonment rates have everything to do with financial accessibility. Prescription abandonment rates are less than 5% when the prescription costs nothing out-of-pocket, but jump to 45% when the cost is over $125 and to 60% when it’s more than $500, according to a 2020 report by the IQVIA Institute for Human Data Science.
As Costs Rise, Revenue and Morale Decline
Of course, patients aren’t the only ones suffering under the weight of increasing drug prices. Medication nonadherence costs the healthcare system an estimated $672.7 billion each year, and specialty pharmacies and infusion centers face significant revenue loss as a result of prescription abandonment. One study suggested that abandoned prescriptions cost pharmacies more than $500 million every year—and that’s a conservative estimate.
For many specialty pharmacies and infusion centers, prohibitively high prescription costs are a frustrating and time-consuming barrier to providing patients with the best possible care. The many financial resources specialty pharmacies and infusion centers navigate on behalf of patients include:
- Drug manufacturer copay assistance
- Free and replacement drug programs
- Disease-specific funds from charitable organizations
- Government grants
- Health systems’ internal charitable funds
Sorting through and matching patients with relevant assistance options is a cumbersome process, especially when pharmacies often rely on inefficient methods.
Leveraging Technology to Connect Patients With Assistance
Fortunately, new technologies are streamlining the work of helping patients access financial assistance. What is often a fragmented and expensive process can now be optimized and automated with the help of financial navigation platforms like TailorMed.
Here are three key ways specialty pharmacy and infusion center staff can leverage technology to swiftly connect patient with the financial resources they need:
1. Proactive Patient Identification
Specialty pharmacies often aren’t aware of a need for financial assistance until after a prescription has been billed and the patient can’t afford the copay. This all-too-common scenario can be avoided if the pharmacy has the tools to proactively identify patients at risk of financial distress before their prescription is adjudicated and the medication is ordered.
Using the power of predictive analytics, specialty pharmacies and infusion centers can leverage data to flag patients who are at risk of financial hardship and project out-of-pocket costs for the entire medical journey.
This projection allows pharmacy technicians, care coordinators, and other staff to proactively assess a patient’s ability to cover their share of treatment costs, and to connect the patient with the best resources to afford care.
2. Optimized Patient Matching
Typically, specialty pharmacy staff must manually run reports to match patients with financial resources, and windows of funding opportunity often close quickly. “Pharmacies are extremely busy with processing prescriptions, calling insurances, and more,” says Chan. “They don’t have a whole lot of time to search out charitable foundations and other resources.”
Not only does this process drain the staff’s time, but it increases the risk that a fund will close before a patient has been enrolled.
With the help of a software solution, pharmacy technicians and care coordinators can quickly find a list of relevant funding opportunities—along with the most expedited options available to enroll the patient.
3. Automated Enrollment and Tracking
Managing the specialty and infusion therapy prescription process with phone calls, paper, and faxes requires an inordinate amount of time. Manual processes may limit the pharmacy’s ability to identify financial assistance programs for eligible patients in a timely manner. This can lead to missed opportunities and, potentially, prescription abandonment.
Automating the enrollment process reduces manual workflow—no more hastily scrawled Post-Its or unwieldy Excel spreadsheets—and improves communication among pharmacy staff, freeing up time and boosting morale. As Chan points out, it can also help build patient loyalty: “When a pharmacy helps a patient find assistance for high-cost medications, they are forever grateful and keep coming back.”
In the case of health system specialty pharmacies (HSSPs), technology can continue to boost efficiency by managing free and replacement drug orders. Typically, the complex and convoluted process of ordering, tracking, and billing must be repeated for each treatment cycle. Digital tools can help pharmacy staff view and track relevant details—such as when a drug was ordered, when it will be administered next, and when it needs to be reordered—in one centralized, easy-to-navigate space.
Given that about 75% of pharmacists who participated in a recent workplace survey said they don’t have enough time and personnel to safely perform or meet duties, streamlining the enrollment and ordering processes could make a critical difference.
Supporting Patients Through Challenging Times
To meet the challenges faced by patients who use high-cost medications, specialty pharmacies and infusion centers can benefit from technology solutions that identify potential financial problems more efficiently—and solve them more effectively.
These are difficult times for patients—and the pharmacy staff who work so hard to serve them. Being able to swiftly connect more patients with financial assistance for their lifesaving medications can make the hard moments a little easier to handle.
“Financial navigation, with the support of technology, can help the mind, body, and soul of a patient,” says Chan. “If we can take away the financial toxicity of an illness, the patient can focus on getting well, increasing the likelihood that they will stay on treatment and recover.”