By James Cornicelli

Specialty drugs have changed the lives of millions of patients suffering from severe, debilitating diseases. These innovative miracles have been incredibly valuable in the health care system.

The caveat is they are also typically priced much higher than traditional drugs, accounting for ~2% of total prescriptions and 32% of all prescription drug spending. Specialty drugs are priced higher for a variety of reasons including increased cost to develop and manufacture these medicines, smaller patient populations, and the patients services required to support patients who will take these medicines. Nevertheless, despite the expensive nature of specialty medicines they have changed the lives of millions of patients and decreased the overall cost to manage these patients. The drugs themselves have been a welcome addition to physician armamentaria, but not without a significant psychological and financial cost to the physician's office, which is sometimes not taken into consideration.



Because of the direct cost associated with these treatments, insurers insist on the judicious use of these medicines using a prior authorization process which ensures only qualified patients receive these medicines. These processes are a costly burden on physicians and their staff as they consume a lot of resources in the physician office. Physicians often need to hire extra staff just to process these prescriptions. In many cases, nurses, NPs, PAs and medical assistants are consumed with managing the prescribing process. Rather than attending to patients they are attending to jammed printers and fax machines. Unacceptable.

The prescribing process is likely not what you think. It includes processing cumbersome paperwork not only for the pharmacy prescription but also the prior authorization and the enrollment forms for necessary patient services. If that isn’t enough, they have to capture patient signatures before they leave the office or through the mail if the patient has left the office. Lastly, the health care professional has to make sure they are enrolling the patient at the correct specialty pharmacy, which is often a lot more difficult than it seems, due to contractual arrangements made by each patient’s insurer, which limit the pharmacies that can dispense the drug.

That’s just to start the process. Working through the prior authorization comes next, and is often a nightmare of faxing and phone calls, trying to ensure that the insurer has all the clinical information they need to approve the prescription. The entire process can take weeks. In that time the patient is suffering, the physician and their staff are exhausted and stressed, patients are unhappy with the service they are receiving, and everyone is wondering why this is so archaic and difficult.


According to a survey conducted by the AMA in December 2016, only 40% of primary care and 60% of specialty physicians routinely complete prior authorization orders in their practice. This is mainly due to PAs relying on outdated methods such as fax order forms and multiple rounds of phone tag. Legacy EHR systems deployed across much of the health care landscape prevent physicians from getting the information they need, digitally, across the spectrum of care, leaving many to revert back to paper and fax. Many providers aren’t aware if and when a PA is approved or denied until they make a phone call to the pharmacy after being prompted by desperate patients and caregivers. Instead of getting tangled up in this quagmire, they are forced to abandon the process and switch treatment strategies. This is not how it should work.

Luckily, with today’s innovative minds in health care and next-generation technology, it is easier than ever before to develop solutions that streamline this cumbersome process, relieving the administrative burden for clinicians and their staff, and in turn, leading to positive outcomes for patients.

So what can be done? A look into the future.
Adopting next-generation tools and technology digitizing the current process, and building a network of health care stakeholders, will help reduce the administrative burden on physicians and get patients their treatments faster. Instead of dealing with fax machines, physicians can then order a specialty prescription, thereby eliminating the paperwork needed to get the medication approved, obtain signatures, enroll patients in critical services, and follow its progress all the way to the patient’s hands – all through the screen of their smart phone and computer.

Today’s systems can also do most of the heavy lifting for the health care management team, including notifying patients or clinicians when things stall. By having an accurate and easily accessible record of regimen and prior authorization history, physician and clinical staff’s administrative time can be significantly reduced and current manual workflows can be automated.

With this increased level of transparency, physicians now have a better lens into the available treatments under each patient's insurance plan, even the preferred medications. They can better inform their patients on the status of the prescription and even enroll patients in programs that ship starter kits, so that patient can get on drug as soon as possible. To take it one step further, new technologies can also help patients to find the financial help they may need to pay for these medications. This will improve patient satisfaction and speed up time-to-treatment dramatically.

Many companies today are dedicated to solving the larger issue within health care of filling the gaps and creating a more transparent, simple process. For specialty pharmacy, this resolution is not only crucial for lessening administrative burden and reducing physician/clinician burnout, but significantly improving patients' lives. While we have a way to go, the progress we’ve made as an industry to date is promising. and over the next few years, hopefully sooner, we will start to see a significant improvement in the prescribing process, enabling easy and expedited access to lifesaving treatment.


About the author: James Cornicelli, is VP of corporate strategy at ZappRx