The use of specialty medications is on the rise — especially for the growing number of patients who are chronically ill with such complex diseases as cancer, multiple sclerosis and rheumatoid arthritis. However, these drugs are expensive and complicated to prescribe and dispense. Now that electronic prescribing (ePrescribing) is the norm for most other medications, it increasingly is being viewed as a solution to reduce the costs and administrative burdens associated with specialty prescribing.
Increased spending and utilization are major reasons why stakeholders are looking to ePrescribing as a mechanism to help contain the costs of specialty medications. Growth in spending for specialty drugs is far outpacing that for traditional drugs, and many new ones are in the pipeline. According to a 2013 analysis by Express Scripts, domestic spending on specialty prescription drugs is projected to increase 67% by the end of 2015. By then, cancer, multiple sclerosis and such inflammatory conditions as rheumatoid arthritis — all specialty conditions — will account for higher drug spending than any other therapeutic class except diabetes. A separate analysis by Prime Therapeutics predicts that, based on recent average yearly increases, specialty drug costs will rise 15 percent annually while non-specialty drug costs will remain flat. At this rate, specialty medications are expected to account for 50 percent of overall drug costs by 2018 for commercially insured individuals.
These huge outlays are directly related to the micro-level costs and use of specialty medications, which payers and pharmacy benefit managers (PBMs) are struggling to manage. Specialty medications often cost more than $2,000 per month per patient. Many cost much more, with the most expensive specialty drugs running upward of $100,000 to as much as $750,000 annually. This represents an obvious economic challenge for payers, while copays can be budget busters for many patients.
Specialty prescribing stakeholders also are looking to improve work flow and savings on administrative overhead through ePrescribing. Specialty prescribing has been mired in paper and yesterday’s phone-fax processes, and should be brought into the digital age. ePrescribing can help facilitate the prior authorizations (PAs) that are needed for many specialty medications, reducing extensive outlays by pharmaceutical companies for administrative assistance for prescribers and patients and getting PAs approved much more quickly. The result: improved sales and less abandoned prescriptions. ePrescribing also can assist with risk evaluation mitigation strategies. For example, ePrescribing could streamline the coordination and communication of the “authorization identification,” which is necessary for medication ordering and patient reporting.
While ePrescribing holds much promise for addressing costs and workflow issues associated with prescriptions for specialty medications, they are outside today’s ePrescribing process. Stakeholders have been working on solutions and progress has been made. As nationally known experts in health information technology (health IT) and ePrescribing, Point-of-Care Partners (POCP) has four ideas on how to gain additional traction for ePrescribing of specialty medications.
- Continue forward motion on a standard. The National Council for Prescription Drug Programs (NCPDP) has made changes to the formulary and benefit standard to incorporate information about which pharmacies are included in specialty distribution for specific products and payers. If the modification is withdrawn in the Formulary and Benefit Taskgroup at the November NCPDP Workgroup meeting, it would create a setback for ePrescribing of specialty medications.
- Increase use of PA flags. To enhance ePrescribing of specialty medications, it’s also critical that the drug includes a PA indicator in the Formulary and Benefit data supplied to electronic health records if a prior authorization is needed. However, few PBMs identify all PA drugs in their formulary data. Increased use of PA indicators could lead to identifying the need for a PA in the physician’s office, rather than at the pharmacy after the prescription has been written. Faster turnaround of PAs and more streamlined processes are needed by both providers and specialty pharmacies.
- Add needed patient and clinical data. Safe and appropriate prescribing of specialty medications depends on a wide range of data, such as a patient’s weight, diagnosis and laboratory values. These are especially important for correct dosing, for example. While these are outside of today’s ePrescribing processes, stakeholders continue to work on related standards and software. Including these data elements in the ePrescription will enhance the timeliness and quality of the specialty prescribing process, as well as improve patient safety and specialty pharmacy efficiency.
- Step up manufacturer involvement. For pharmaceutical manufacturers, ePrescribing of specialty medications represents an opportunity to identify appropriate patients for a designated drug while reducing approval obstacles for physicians. As more complicated medications come to market, physicians and plans increasingly must identify appropriate patients. That’s why manufacturer involvement in supporting ePrescribing of specialty medications is important and will benefit all stakeholders.
Edited by
Blaise McNamee
