Efforts to Automate Specialty Pharmacy Will Accelerate in 2019

By Tony Schueth, CEO and Managing Partner

Specialty medications are high-cost, complex drugs with special handling and delivery requirements. They are primarily used to treat rare or chronic conditions. Retail pharmacies are highly computerized and most noncontrolled substances are prescribed electronically. In contrast, specialty pharmacy has lagged behind and is ripe for automation. Specialty medications are generally still being prescribed using antiquated paper-phone-fax methods. This results in significant delays in getting needed medication to the patient. The speed-to-therapy lag is a major pain point for both patients and providers, which also has implications for the quality and safety of care.

The industry has been working to develop standards as well as fill information and workflow gaps related to the unique requirements of specialty prescribing. Many of these issues will be addressed by the new Task Group for Specialty Prescribing, which was created by the National Council for Prescription Drug Programs (NCPDP). It is chaired by our own Pooja Babbrah and a colleague, Laura Topor.

We expect that these and other efforts to automate specialty pharmacy will accelerate in 2019. For example, we predict that:

1. Automated methods for enrolling patients in specialty programs will emerge. NCPDP will draft a standard to automate patient enrollment forms, and other proprietary methods will emerge. This component of specialty pharmacy is key to ensuring that patients start off on the right foot and provide the payer and provider with the information needed to process and dispense/ administer a specialty medication. Key stakeholders and standards development organizations are stepping up to make this happen.
2. Stakeholders will accelerate automating various facets of specialty prescribing, such as patient outcomes reporting and requirements associated with Risk Evaluation and Mitigation Strategies (REMS). The Food and Drug Administration (FDA) requires REMS for specific high-risk medications. They include complex processes for educating patients and physicians about a drug’s safety and various criteria prescribers must meet to ensure safe use, such as physician certification in order to prescribe the drug, patient enrollment in a central registry and restricted distribution of the drug to certain specialty pharmacies. Assessments and reports must be done periodically and provided to the FDA and the drug’s manufacturer. Currently, this involves time-consuming, labor-intensive, paper-phone-fax based processes, which are ripe for automation.
3. The industry will finally grapple with solutions to definitively identify who owns coverage for a patient at the point of prescribing. Currently, prescription drugs may be covered under the patient’s pharmacy benefit, medical benefit or both. This also has implications concerning which pharmacy may fill the order. The lack of clarity results in frustration and expands time to therapy, which has implications for patient safety and quality of care.
4. A baseline study of speed to therapy will be conducted. Key stakeholders who understand specialty prescribing will conduct a definitive, scientific baseline study of the speed-to-therapy lags associated with specialty prescribing. It will measure timeframes for prescribing, processing and receipt of medications as well as target areas for improvement.

Point-of-Care Partners is heavily involved in laying the groundwork for automating specialty prescribing.  For more information and a sense of the landscape, feel free to contact me, tonys@pocp.com, or Pooja Babbrah, pooja.babbrah@pocp.com.