Patients struggling with complex medical conditions face a growing number of barriers to access, afford, and adhere to the innovative therapies their providers prescribe. In 2022, out-of-pocket costs led to the abandonment of 94 million prescriptions. And in a 2023 survey, 97% of medical practices said their patients had experienced care delays or denials due to increased prior authorization requirements.
Life sciences manufacturers continue to seek new ways to improve the patient access journey to make it easier for patients to start on therapy. One model in particular, non-dispensing pharmacies, can be a powerful tool to break down barriers to medication access. These innovative pharmacy constructs do not hold inventory or dispense medications but instead focus on streamlining the patient access journey by serving as a bridge between the HCP and the dispensing pharmacy to benefit patients, HCPs, and manufacturers.
Upon receiving the prescription, a non-dispensing pharmacy processes benefit verifications, prior authorizations, copay programs, and any other pre-fulfillment needs before transferring it to a dispensing pharmacy for adjudication and fulfillment. Additionally, since pharmacies are considered HIPAA Covered Entities, HCPs do not have to form a Business Associate Agreement (BAA) to share patient health information. This intermediary can be instrumental in simplifying the patient's treatment journey in an era where dispensing pharmacies are facing challenges on multiple fronts by enhancing their experience and improving access as follows:
Today's patients expect to be active consumers of healthcare services but often lack the transparency to make informed decisions about a prescribed treatment. Effective, non-dispensing pharmacies can deliver frictionless, consumer-centric experiences offering enhanced transparency that gives patients complete visibility into the status of their prescriptions, ensuringes they are aware of available patient services, and can seamlessly enroll in any copay programs they are eligible for.
The PA process frequently leaves patients waiting for extended periods of time for a coverage decision, and denials may occur for a host of reasons despite a therapy being appropriately prescribed. These therapy delays can profoundly impact individuals' health and often result in patients abandoning therapy. An integrated, non-dispensing pharmacy that is digitally equipped to manage PAs will help patients get started on their prescribed therapy more quickly and help them stay adherent.
Burdensome PA requirements and staff shortages exacerbate HCP time constraints and administrative demands. At the same time, six out of ten providers report that they are uncertain of the insurance benefits information needed to start patients on complex therapies. While many HCPs regularly use e-prescribing, many brands still require them to go to a website, download and fill out a form, and fax it to the brand’s hub. All of these factors can negatively impact the adoption of a branded therapy if providers anticipate patient access will be difficult.
A tech-enabled, non-dispensing pharmacy can meet HCPs where they are by:
Integrating seamlessly into their current workflow - accepting e-prescriptions through electronic health records (EHRs) as pharmacies and eliminating the hassle of determining the right pharmacy to utilize based on a patient’s insurance
Smoothing the prescribing process by transferring relevant patient information from the EHR to ensure quality scripts that are more likely to get coverage
Alleviating the PA administrative burden by automating and managing the process from start to finish before transferring to the dispensing pharmacy
Ineffective pharmacy networks can diminish a brand’s reputation, patient and provider satisfaction, health outcomes, and gross-to-net. And strong market access, the ability of a pharmaceutical manufacturer to secure reimbursement and coverage for their products from payers, does not always translate to covered dispenses at the pharmacy.
Access partners that utilize non-dispensing pharmacies can help manufacturers navigate retail pharmacy challenges and eliminate the risks of relying on the traditional prescribing process by:
Decreasing prescription abandonment by ensuring the dispensing pharmacy is contracted with a patient's insurance plan
Increasing PA submission and approval rates by providing tech-enabled PA Support
Improving medication adherence and refill rates by supporting better continuity of care
Enabling better decision-making with more visibility into key metrics around benefits verification, PAs, health plan PA behavior, and reimbursement rates
Optimizing copay programs for financial sustainability by adhering to manufacturer business rules
Providing mechanisms to ensure a brand is dispensed as written at the retail pharmacy
Achieving strong market access for a specialty-lite brand does not guarantee that the patient can access the therapy reliably or affordably. This may explain why more than one of three new drug launches fall short of expectations. Integrated hubs with non-dispensing pharmacy models can break through these barriers.
PhilRx is a scalable, end-to-end commercialization platform that helps specialty-lite brands protect their gross-to-net margins while facilitating access, unlocking coverage, and maximizing adherence. Our platform utilizes a non-dispense pharmacy that bridges our digital hub with an integrated nationwide pharmacy network to ensure patients receive prescribed therapy quickly, conveniently, and affordably. Our consultative approach is guided by real-time insights that provide strategic visibility across the prescription journey to improve brand performance.
Book a demo of the PhilRx patient access platform today to discover first-hand how your brand can benefit.
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.