Market challenges & innovative digital solutions from the patient's perspective
Core Concepts:
Extending prior authorization transparency to patients and market access teams has profound implications. Through the lens of Joan's experience, we underscore the urgency for efficient solutions. CassianRx's innovative approach boosts market access teams' effectiveness by improving patient engagement and transparency.
Market Access Challenges: Prior authorization hurdles lead to treatment delays, adverse events, and inadequate patient outcomes.
Financial Implications for Manufacturers: Delays and non-transparent PA processes for patients leads to measurable loss of revenue
Empowering Market Access Teams: Market access teams benefit from real-time insights and patient involvement for smoother interventions powered by AI & Machine Learning
Every Thursday, Joan would leave work dressed in biking attire to join her colleagues in the parking lot for their weekly bike ride. At 57, Joan was known as the leader of the pack for outdoor activities. When her oldest son, Colton, visited her from college in the late fall, he noticed she was less active than usual. She noticed it too.
Over the subsequent two years, Joan grappled with perplexing and challenging symptoms that were initially mistaken for the flu. She experienced heightened sluggishness and felt “turned around”. She began to suspect it was all in her mind. It was after consulting with a specialist and undergoing a series of lab tests that she received her diagnosis: Multiple Sclerosis.
With appropriate treatment, Joan managed to rejoin her pack and resume her bike rides. Yet, the following spring brought numbness to the left side of her body while at work. Anxious about the progression of her symptoms and the potential impact on her active lifestyle, Joan promptly contacted her specialist. Recognizing the urgency, they jointly decided to switch to a medication that could better manage her advancing symptoms.
As she left her doctor's office, Joan anticipated picking up her new medication on her way to dinner with her husband. To her surprise, she learned that this prescription required prior authorization, which could take several days.
The next week proved bewildering for Joan. She struggled to comprehend the delay and the lack of improvement in her symptoms. The numbness on her left side persisted and a sense of malaise grew. She eagerly awaited a call from her doctor, only to discover that her initial prior authorization request had been denied by her specialty pharmacy. The denial required additional documentation for approval.
Despite her diligence, Joan felt baffled by the situation. She wondered why she remained uninformed about the process and why she couldn’t begin treatment.
A Familiar Tale with Broader Implications
Prior authorizations place an onerous burden on physicians, contributing to burnout, disruptions, and suboptimal treatment outcomes.
A staggering 94% of physicians report that prior authorizations result in care delays. (1)
To mitigate burnout, 35% of physicians rotate their care team staff dedicated to prior authorizations. (2)
Remarkably, 50% of specialists opt for subpar treatments due to perceived burdens associated with prior authorizations. (2)
Patients Bear the Brunt
For one-third of physicians, delays in prior authorizations lead to serious adverse events. (1)
Unnecessary hospitalizations stem from prior authorizations for 25% of physicians. (1)
Shockingly, 9% of physicians report permanent disability, physical harm, birth defects, or fatalities linked to prior authorizations. (1)
Large Financial Consequences for Manufacturers
Pharmaceutical manufacturers invest significantly in patient support to expedite access to life-saving medications. However, delays in prior authorizations result in substantial revenue losses.
Prior Authorizations lead to costly delays in beginning treatment for many indications. This can be as high as 3.6 days for cancer drugs and up to 31 days for RA and inflammatory bowel disease. (1)
The delay caused by prior authorization lowered initiation of specialty treatment by 26%,35 (1)
For two multiple sclerosis manufacturers specifically, this leads to an annual loss of revenue of $187 Million to $1.01 Billion dollars for two of the leading marketed drugs in 2022. (1,3)
A Path Forward: Transforming Patient Access Transparency:
Pharmaceutical manufacturers' hubs and patient support programs are dynamic entities that address barriers patients commonly encounter when initiating treatment. Recent studies indicate that 94% of patients value knowing their prior authorization outcomes, expediting treatment commencement by 1.5 days. (4)
Integrating proactive patient engagement within these programs empowers patients to actively participate in their care. This involvement not only benefits patients but also provides manufacturers with actionable insights.
Challenges to Patient Involvement:
Why is Joan unable to be actively engaged in her care? The impediments to seeing and communicating patient progress within market access roles are threefold:
Disparate Stakeholders and Lack of Accurate Patient Statuses: Discrepancies arise as patient progress within hospital owned specialty pharmacies might remain unreported to pharmaceutical manufacturers relative to "in-network" pharmacies.
Restrictions in Viewing Patient Progress: Comprehensive and de-identified patient progress data across the entire journey are often inaccessible to market access teams, limiting their interventions.
Limited Patient Engagement Infrastructure: Even if patient involvement accelerates new starts, automated enrollment, dynamic interactions, branded engagement, and patient activation are absent in most channels.
Proposing a Solution: CassianRx's Approach
At CassianRx, we streamline patient statuses across specialty channels, offering patients like Joan a transparent view of their treatment journey. This fosters active participation and quicker initiation. Every patient touchpoint contributes to informative data submission, expediting new starts.
Additionally, our AI models predict and engage patients when they are most receptive, leveraging behavioral, archetypal, and socio-economic data.
Reimagining Joan's Journey
Introducing CassianRx's method of access transparency and activation transforms Joan's experience:
Upon prescription, Joan receives a digital checklist and videos from peers sharing their treatment journeys.
Joan can proactively upload insurance and historical data, addressing potential prior authorization gaps.
A live portal provides real-time updates on her authorization status, offering clarity.
Joan can self-report challenges, enabling personalized support
Enhancing patient engagement, transparency, and involvement in the prior authorization process benefits patients and manufacturers. Patients gain insight into their journey, while manufacturers gather valuable feedback to refine support strategies. CassianRx's solution empowers patients like Joan, transforming their access to care.
About the Author
Dr. Collin Wolf is a PharmD & Preceptor from the University of Pittsburgh School of Pharmacy. Collin is driven by making the best patient experiences for patients within Specialty Pharmacy, Hub & Pharmaceutical Manufacturer Channels.
To learn more contact: Collin.Wolf@Cassianrx.com | 908-303-8924
References:
2 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9060934/
4 - https://www.covermymeds.com/main/prior-auth/?utm_medium=publications&utm_source=drugchannels&utm_campaign=epa-provider-medicationaccess&utm_content=landingpage-epa
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