Resources

Editor’s Note: With the convergence of rising operational costs, complex utilization management (UM) requirements, and healthcare consumerization, life science manufacturers are flying blind if they are not tracking every prescription from when it’s written until it’s either dispensed or abandoned. If brands are not leveraging this information to drive patient access strategy, they are at a competitive disadvantage as failure to do so adversely impacts the patient experience and gross-to-net (GTN). While most manufacturers recognize the value of such data, it’s typically hard to come by and challenging to translate into actionable insights

The use of prior authorization (PA) to control the utilization of prescription drugs, especially specialty medications, is growing, with 79% of medical practices reporting that PA requirements increased between 2021 and 2022. By design, the 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. The negative consequences of delaying treatment are well documented, yet more than 8 out of 10 patients still experience delays accessing their medications for reasons such as cost and insurance challenges

As healthcare costs have escalated over the last several decades, public and private medical insurers have introduced different utilization management (UM) strategies to control healthcare expenditures. The proliferation of higher-cost specialty medications has accelerated the use of drug UM tools to control access, with prior authorization (PA) being the most common today. From the payer's perspective, PAs are necessary to improve quality of care and protect patients’ safety

Editor’s Note: One of the silver linings of the COVID-19 pandemic is that it accelerated the digital transformation of the United States healthcare ecosystem. Essentially overnight, the healthcare system flipped from a model that relied nearly exclusively on in-person care delivery to a blended care model mixing in-person and virtual. Key healthcare stakeholders (HCPs, patients, caregivers), accustomed to seamless digital experiences in other industries, were eager to adopt more widely accessible digital health technologies during the pandemic and continue to demand new ways of managing their health

Editor’s Note: In the era of specialty launches and increased payer utilization management requirements, life sciences brands need to be strategic to overcome prior authorization hurdles if they wish to unlock patient access to drive brand growth. Commercial leaders understand that utilization management requirements like PAs can be disruptive in the prescription access journey - often resulting in prescription abandonment and misaligned incentives that can impact brand growth. Despite this reality, most brands have been unsuccessful in creating actionable, real-time feedback loops on the prior authorization process that allows them to respond to the dynamic challenges facing their brands