I started my career in specialty pharmacy because I wanted to help deliver lifesaving care to patients with chronic conditions. As someone who is passionate about customer service, I loved working in a field that treats patients and their families like people—taking the time to get to know them and making sure they feel supported every step of the way. I’ll never forget delivering chemotherapy medications to the home of a patient with glioblastoma, an aggressive type of brain cancer. I remember the feeling of gratification as he and his family invited me in and told me how much they appreciated the personal touch. When I left their home, it felt so rewarding to know that I had played a role in his care journey, no matter how small.
At the same time, during my 13 years in the field, I also watched far too many patients struggle to afford their high-cost medical care. The reality is that specialty drugs for conditions such as cancer, multiple sclerosis, and rheumatoid arthritis can be very expensive. It didn’t surprise me to learn that while specialty drugs represent a fraction of the total prescription drug volume in the U.S., they account for more than 50 percent of the national drug spend.
Rising drug prices and soaring out-of-pocket costs present a serious obstacle to treatment adherence. In fact, a recent survey found that nearly 13 million U.S. adults per year skip or delay filling needed prescriptions due to cost—leading to poorer health outcomes. This is a challenge not only for patients and their caretakers who are struggling to get access to the care they need, but for the entire healthcare system. Providers are dealing with uncompensated care and bad debt, while pharmacies face prescription abandonment, loss of revenue due to treatment delays, and an overall strain on their resources due to increased calls to physician offices, insurance companies, and more.
Those of us who have worked in the specialty pharmacy field understand that we’re responsible for treating the whole patient. This means not only administering medications, but also providing patients with all the support they need to afford their care. Specialty pharmacies—whether hospital-based or independent—can and should put systems in place to ease the financial burden. And to their credit, many have.
Tools to Reduce Costs for Patients
Fortunately, numerous resources are available to reduce out-of-pocket expenses—from charitable funds to government grants to manufacturer copay assistance. However, the process of finding and enrolling patients in financial aid is often manual, cumbersome, and reactive. The good news is that in recent years, digital tools have emerged to address this growing need. Here’s how technology can help specialty pharmacies connect patients with vital cost-saving opportunities:
1. Leveraging Data to Flag Patients in Need
All too often, specialty pharmacies only learn of a patient’s financial need after a prescription has been adjudicated and the patient is unable to afford their copay. In many cases, the pharmacy technician or care coordinator must then go back to the provider to relay the patient’s inability to pay for the medication. The provider then changes the patient’s medication to a second- or third-choice option.
This unfortunate 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. By harnessing the power of technology, specialty pharmacies can leverage data to flag at-risk patients on the front end. Software solutions have the capability to analyze a patient’s profile—including their diagnosis, treatment plan, and healthcare coverage—and then project out-of-pocket costs for the entire medical journey. These data points empower pharmacy staff to proactively and efficiently assess patients’ ability to pay their share of treatment costs—and then connect them with resources to afford care.
2. Automating and Optimizing Enrollment
Once a patient has been identified as being at high risk of financial distress, there are ample resources available. For example, charitable organizations such as the PAN Foundation, the Patient Advocate Foundation, and the HealthWell Foundation offer disease-specific funds to help patients afford treatment. Typically, specialty pharmacy staff must run reports on these organizations manually—and funds often close quickly. This process not only drains the staff’s time, but also runs the risk that a fund will close before a patient has been enrolled.
Technology can help close these gaps by automating and optimizing the enrollment process. By utilizing a software solution, the pharmacy technician or care coordinator can quickly find a list of relevant funding opportunities—along with the most expedited options available to enroll the patient. These tools also simplify the cumbersome task of filling out enrollment forms and streamline communications among pharmacy staff. The results? A more efficient workflow for the pharmacy with greater cost savings for the patient.
3. Streamlining Prescription Drug Orders
Many pharmaceutical companies offer free and replacement drug programs for patients in need of financial assistance. In a hospital setting, specialty and infusion pharmacies are often responsible for managing these free and replacement drug orders.
Once the patient is enrolled in a program, technology can streamline the process of ordering, tracking, and billing each order. Typically, this complex, multi-step process must be repeated for each treatment cycle. It’s not uncommon to find specialty pharmacies using paper calendars, yellow post-it notes, and notebooks—once again producing a manual, inefficient system. Digital tools can help pharmacy staff maximize their efforts, enabling them to 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—all in one centralized space. By creating a well-organized, integrated experience, these solutions empower pharmacies to be proactive, plan ahead, and ensure the seamless delivery of medications to patients in need.
Saving Costs, Saving Lives
Specialty drugs offer a lifeline for patients with chronic, serious, and rare conditions. But these drugs come with a heavy price tag, leaving many patients struggling to pay for the treatment they so desperately need. Specialty pharmacies can play an essential role in removing financial barriers to care—and technology can make a tremendous difference. By investing in cutting-edge software solutions, specialty pharmacies can live up to their missions to treat the whole patient, including their financial health. As I learned during my years in the field, specialty pharmacies are committed to going the extra mile for patients and their families. Now, it’s time to use every tool at our disposal to ensure that nothing stands in the way of patients getting the lifesaving care they deserve.
Bryan Bloom was a founding partner and board member of a national and fully accredited specialty pharmacy business. Bryan was also a member of the Board of Directors at Stupid Cancer, a leader in young adult cancer advocacy, research, and support. He joined TailorMed as Director of Sales in 2020.