Inefficient Access Pathways Cost More Than Just HCP Time and Effort

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There may be no greater threat to patient outcomes than the current barriers to therapy access—especially for specialty medications.

OptimizeRx surveyed 100+ physicians across five specialty areas to understand how inefficient access pathways impact their care decisions. We found that 66% of HCPs reported they would prescribe a different medication for 25% or more of their patients if market access wasn’t a factor. What’s more, 53% reported having to change their care plan for 25% or more of their patients due to access barriers. These results suggest that market access teams’ current strategies are falling short of their access goals. 

Something Is in the Way

It’s well known that market access teams face significant challenges when negotiating formulary placements.
The nature of the U.S. healthcare market means that specialty medication access will always require some effort by prescribing physicians and their office staff. However, overly manual and inefficient access pathways compound the effort required, to the point it impacts care decisions for patients.

For example, we found that HCPs and their office staff spend nearly 4 hours per day helping patients access their medications—at an average practice cost of $5,800 a month. But with so many payers and their unique plans, so little communication, and constant formulary changes, brands continue to wrestle with restrictions while providers remain overwhelmed, struggling to prescribe their preferred patient therapy.     

Decentralization and Lack of Visibility

Prior authorizations and hub enrollment are two of the first burdens physicians and their office staff needs to manage, but too often these still require inefficient paper forms, manual data entry, or navigating a multitude of individual websites. And that’s before the actual process of documenting the patient’s medical need for a specific product or negotiating with the payer to provide coverage.  

In addition to the time and cost burdens of inefficient access pathways, physicians also lack the visibility they need into formulary coverage and payer restrictions. We found that 60% of the specialists we surveyed do not have real-time access to patients' insurance benefits information. Without visibility into patient coverage, there’s no way for them to help patients find the most direct path to their medications, which lengthens the time before patients can begin treatment.

Another common barrier to rapid specialty therapy initiation is a lack of visibility into distribution networks. Picture this: A provider sends a prescription to the patient’s preferred local pharmacy. But when their patient tries to pick up the prescription, the local pharmacy doesn’t carry it. Now the patient must return to the provider, creating another set of delays before starting therapy. Not only is this burdensome for patients and providers, but it can have a real impact on patient outcomes—including worsening medical conditions, hospital readmissions and increased healthcare costs.

Overcoming Access Barriers with Digital Tools at the Point-of-Care

Overcoming these barriers requires simplifying and streamlining the prescribing process for specialty medications, reducing avoidable complexity, and making it easier for physicians to start patients on their preferred therapy. And a digital market access toolbox is the first step in this process.

The most efficient digital solutions are those that integrate directly into the EHR workflow, so physicians and office staff can manage the steps required to initiate therapy at the point-of-care. And the physician interest in these tools is high. When we asked physicians how helpful certain EHR-based technologies would be, 84% responded that a tool to help file prior authorizations more easily would be “very” or “extremely helpful,” and 81% said the same about a tool that automates the specialty or hub enrollment process. They also expressed high levels of interest in tools that increased visibility into patients’ insurance benefits —71% of physicians with access to this information routinely check it, but 60% of physicians don’t have it available to them.  

Ready to Remove the Obstacles for Your Brand?

With the right digital tools driving your access strategy, you can give physicians the informed perspective they need to prescribe your brand with confidence, emphasizing their judgment instead of over-weighting access roadblocks. In addition, shifting away from manual processes helps minimize errors and omissions, reducing the back-and-forth of authorization work. And most importantly, patients can start taking their urgently needed medication sooner than ever. 

OptimizeRx therapy initiation solutions integrate directly into EHR systems for streamlined therapy initiation and onboarding. Learn how you can bridge the gap and transform the access workflow for your brand, while improving provider and patient experience. Connect with our team today for an initial conversation. 

About the Physician Survey

OptimizeRx surveyed 100+ physicians across five specialties to understand the challenges they face and the solutions they need to improve therapy access and initiation. What kind of EHR technology solutions would providers find most helpful? Where do physicians encounter the most difficulties starting patients on specialty medications? Download our new infographic to see the results.