The timely initiation of a prescription therapy is critical to patients' health and quality of life and can often be a matter of life and death. Yet, a 2022 report revealed that more than 8 out of 10 patients encounter frustrating delays in accessing the medications they need to manage their health.
Therapy delays not only have a profound impact on individuals' well-being but also significantly burden the healthcare system. Understanding the root causes of these delays is crucial for developing strategies that enhance patient care, streamline healthcare processes, and ultimately benefit patients and therapy outcomes.
In this blog post, we will explore the most prevalent reasons why patients experience prescription therapy delays and delve into how pharmaceutical manufacturers can play a role in improving speed to therapy to improve outcomes for patients and their brands.
According to a recent survey, the average wait for a physician appointment is 26 days, with the wait times to see specialists typically even longer. Suppose the HCP determines that your specialty or specialty-lite medication will best treat the patient’s condition. In that case, the benefits verification and prior authorization processes can add more days to weeks to the time it takes to get started on treatment.
Strategy to improve speed to therapy: Include a digital direct-to-consumer (DTC) channel, such as telemedicine, as part of your channel strategy. A well-executed DTC model will integrate a telemedicine channel with a digital fulfillment partner to offer an “e-commerce like experience” resulting in the patient having their appointment within a day or two and prescribed treatment in hand a few days later – slashing time to therapy from weeks or months to days.
Step therapy – also known as step edits or fail first – is a common form of drug utilization management used by payers to control costs. This protocol requires that a lower-cost drug in the same therapeutic class be prescribed and fail before allowing coverage of a more expensive option. One study found that health insurance plans apply step edit protocols to nearly 40% of drug coverage policies. Many HCPs suggest that these policies don’t adhere to clinical guidelines. Additionally, the delays in prescribed treatment can be detrimental to patients.
How to drive speed to therapy: Manufacturers should take a proactive approach to help HCPs meet step therapy protocols before a prior authorization expires(PA) resulting in a denial and erosion of confidence in your brand. The best way to accomplish this is to optimize the field team to be more responsive and relevant with HCPs, ensuring they are adequately informed on the insurance coverage requirements such as ICD-10 codes for their patient population.
For a deeper dive on this topic, join our upcoming webinar with Fierce Pharma to learn how to optimize your field team to drive access.
By design, the prior authorization (PA) process is a barrier to medication access – it can leave patients waiting for days, weeks, or even months for approval, and coverage denial may occur despite a therapy being appropriately prescribed. In an AMA survey, 94% of physicians reported patient care delays associated with PAs. The PA process presents a growing roadblock for HCPs trying to get a patient started on the prescription therapy they deem best. In an MGMA Stat poll, 79% of medical practices reported that PA requirements increased in 2022.
How to drive speed to therapy: Considering that 72% of HCPs identify PAs as one of the biggest workflow issues to be solved with technological solutions, it only makes sense that the best way to accelerate access to therapy is to leverage technology to streamline the process. By making prescribing as easy as possible and simplifying the PA process, HCPs are more likely to write scripts and help patients get started on their prescribed therapy more quickly.
Out-of-pocket costs can be a significant factor in treatment delays. In a 2022 report, more than 1 out of 4 patients cited cost as the reason they experienced a delay in accessing their prescribed medication. The report also found that 79% of patients went to the pharmacy but found that the prescription cost was more than anticipated. And among patients facing affordability issues, 56% rationed their medication and 51% abandoned their medication.
How to drive speed to therapy: A data-driven Hub solution with integrated transparency tools that help providers improve affordability conversations with patients so they can make the best decisions at the point of care will go a long way towards avoiding the delays related to cost concerns. For best results, it’s essential to take proactive steps to maximize enrollment in your patient services program and lay the foundation for covered dispenses.
A rapidly evolving pharmacy landscape is introducing new medication access challenges. With over 40% of counties in the U.S. considered “pharmacy deserts” as of 2021 and reports of numerous retail pharmacy closures in recent years, many patients – especially those with mobility issues – are at risk of delays filling their prescriptions due to logistical difficulties.
How to drive speed to therapy: Partnering with a network of pharmacies that offers mail-order services to ensure that patients have uninterrupted access to your prescription therapy is a big part of the solution. You can take access one step further by working with a Hub digital hub with an integrated dispense network that functions as a liaison between the pharmacy and the patient. With business rules that triage each prescription to the pharmacy with the best coverage, you can accelerate access and improve the patient experience.
Want to learn more about how to position your brand for long-term growth? Download our playbook for life sciences manufacturers: “Optimizing Patient Access for Sustainable Growth.”
Our consultants will work with you to analyze your current channel strategy and make recommendations for how to improve patient access and increase the percentage of scripts getting covered by insurance.