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.

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