Earlier this month, leaders across the health care industry descended on Boston for the Future Pharma 2019 Conference. Their purpose? To exchange insight on how best to implement new technologies and strategies for reaching patients with life-changing therapies.
Speakers and attendees representing various life science, biotechnology and health care-related companies shared their experience in applying innovative tools and approaches for driving patient awareness and access. Numerous presentations and round-table discussions were connected by the common thread of improving how health care is communicated and delivered to better help patients get the medications they need to live healthy lives.
Two speakers from CoverMyMeds, Austin Raper, Ph.D., and Dan Kelly, Pharm.D., added to the conversation with a presentation focused on how to improve medication access for patients. During their talk, Austin and Dan highlighted the impact prior authorization (PA) continues to have on patient access to prescription medications. They shared that 12 percent of prescriptions written in the U.S. – over half a billion – are rejected due to PA requirements. Of those rejected prescriptions, 37 percent are abandoned – meaning that 260 million patients are not getting the medication they need to live healthy lives.1 Beyond this impact to patients, PA was described as burdensome to providers and pharmacists who must expend significant time and effort to complete PA requests for patients as reported in recent surveys.2,3
Austin and Dan then described electronic prior authorization (ePA) as a health care IT solution that continues to improve patient access to prescribed medications by streamlining the PA process. For some offices, providers may have to complete upwards of 40 or more PA requests per week, which could mean an additional ~20 hours in administrative labor.4 When all of this work is completed manually (i.e., through phone calls and faxes), there is a good chance that some PA requests will fall through the cracks and never get completed, leading to prescription abandonment by patients. With certain ePA solutions, PA requests are organized within a central location to help optimize provider and pharmacist workflows. As a result of this workflow optimization, more PA requests can make it to the health plan for a determination instead of being forgotten, which was supported by recent data tracking outcomes for PA requests in several top-prescribed therapeutic areas.
A recurring theme throughout many sessions was the importance of data to demonstrate the effectiveness of emergent health care technologies for improving patient outcomes. During their presentation, Austin and Dan revealed new data showing the effect of ePA on how quickly patients pick-up their medications from the pharmacy (i.e., time-to-therapy). For a subset of PA requests, they found that those completed electronically resulted in medications being dispensed to patients a full day or more earlier than those completed manually, on average.4
Such an acceleration in time-to-therapy supports ePA as a true difference-making technology for health care.
Another central theme discussed during the conference involved combining data and technology to advise human action for more predictable and positive health care outcomes. With electronic health care solutions such as ePA, a wealth of information and insight is often available that can be used to guide decision-making of support staff. For example, Austin and Dan described how ePA technology is used to inform the PA process – updating case managers on PA status in real-time to indicate if requests made it to the health plan and if a determination was made.
In the event that a request did not make it to the plan, a case manager can then follow-up with the provider to assist as needed. As a result, more PA requests are correctly completed on average, which can help improve approval rates for determination by 17 percent in some cases.4 In the event that a request received a denial determination, a case manager can identify the reason for the negative decision (e.g., missing/incorrect information, requires attachments, etc. can occur 20 – 50 percent of the time)4 and can assist providers in beginning the appeal process for redetermination.
Through such a combination of technology and support, 51 percent of appealed denial determinations have received an approval upon redetermination in some cases.4
Speakers also aligned on the idea that disruption in the health care space requires quality, access and value. For many emerging life science products, innovative and rigorous science ensures quality and the potential to benefit patient health. However, health care challenges can restrict access to therapies and undermine value through high out-of-pocket costs.
In their talk, Austin and Dan described how patients relying on copay support from life science manufacturers to afford their medications can be exposed to high out-of-pocket costs while in the deductible period of their insurance plans. If a PA request is not started after a patient uses copay assistance at the pharmacy, prescription coverage for the medication may not begin. When their copay assistance limit is reached, the patient may be surprised by an expensive copay requirement, which could lead to prescription abandonment. By automatically starting a PA request when copay assistance is used, Austin and Dan showed that patients can reduce avoidable out-of-pocket spending when their copay assistance limit is reached by 77 percent in some cases.4
Future Pharma 2019 offered health care experts an opportunity to pause and reflect on what is making the most difference for patients now – as these are the technologies, strategies or policies that should be prioritized to shape the future of health care as well. Patient-focused technologies like ePA were recognized for their abilities to augment human intervention in health care while replacing redundant, manual processes.
If you are interested in learning more about how ePA can help patients to access the medications they need to live healthy lives, download our new case study that served as a main resource for Austin and Dan’s talk and accompanies David Holladay’s recent Drug Channels guest post.
- 2019 ePA National Adoption Scorecard, CoverMyMeds, – based on reject codes 70, 25 and MR
- 2018 AMA Prior Authorization (PA) Physician Survey, American Medical Association, 2018
- AmerisourceBergen Pharmacy Check-Up: Activities and Barriers to Care Analysis, AmerisourceBergen Corporation and Maru/Matchbox, 2018
- Comprehensive Prior Authorization Support to Help Impact More Patients, CoverMyMeds Case Study, 2019