In a highly mobile society, patients often find themselves facing changes — expected or otherwise. Patients may choose to switch providers, or a provider may move, forcing a patient to start treatment with a new provider. Patients who switch jobs, move to a new state, or leave work may find themselves switched among payers and payment options.
During all this change, a specialty pharmacy may be the only point of consistency for a patient. With access to specialty pharmacy data gleaned across the patient journey, specialty pharmacists can provide the stability a patient needs when provider and payer relationships change.
Why Patients Need Stability in Times of Change
Changing providers or payers creates uncertainty, yet it’s also quite common. About 69 percent of patients report they’re willing to switch physicians, despite frustrations with the switching process. Younger patients are more likely to make the change, calling for better communication between providers and patients, writes Todd Shryock in Medical Economics.
Patients switching payers occurs frequently too. About 15 to 20 percent of insured individuals, both public and private, change their healthcare plans each year, write Hanming Fang and fellow researchers in a 2022 JAMA article.
For rare disease patients, changes to providers or insurance coverage can create greater than usual levels of uncertainty. Will a new provider understand the rare condition as well as the previous one? How long will it take a new provider to get up to speed on a specific patient’s needs? What paperwork, including pre-authorizations, will a new insurer or payer demand, and how long will this process delay treatment?
Speeding treatment to rare disease patients is essential, says Ryan Haumschild, director of pharmacy services at Emory Healthcare. When patients switch payers, specialty pharmacies can help support patient transitions with assistance navigating paperwork, such as pre-authorizations, and by directing patients to other forms of payer support as needed.
When a patient switches payer and provider at the same time — such as during an interstate move — pharmacy support by way of patient journey orchestration is even more vital. A patient who is establishing a new provider relationship, for instance, may need a specialty pharmacy’s resources to stay connected to payer sources while the new provider’s office handles pre-authorizations and other paperwork. With access to deep data sources and a comprehensive communication platform, specialty pharmacies can provide this support for patients.
Choosing the Right Specialty Pharmacy Data Tools for Patient Support and Medication Adherence Strategies
To provide the support patients need in times of change, specialty pharmacies need access to data that provides a complete picture of the patient journey. Using Hub software is one way specialty pharmacies can gain such access.
By relying on a digital Hub, specialty pharmacists can:
Stay on top of patients’ needs during times of transition. Do patients need a new prescription or a refill? Are pre-authorizations required? What information do distributors need? By keeping provider, payer, pharmacy and distributor information in one place, specialty pharmacies can more easily communicate with patients, helping them maintain access to treatment even in times of transition.
Connect with providers, payers, distributors and the patient in seamless ways. Managing costs is especially challenging for rare disease patients, writes AscellaHealth Chief Pharmacy Officer Andy Szczotka. Without help to handle costs, these patients can face another barrier between themselves and treatment — a barrier that disrupts the work of specialty pharmacies and the distributors that supply treatments on a stringent schedule. The right tools for patient support allow pharmacists to spot issues and address them before the flow of treatment gets blocked completely.
Improve communication for better decision-making across the patient journey. There’s plenty of room for improvement in communication between payers and patients, writes Siva Narayanan in a 2023 article in Future Rare Diseases. Connecting these parties with specialty pharmacies, providers and distributors in a single digital location can boost this communication, benefiting every involved party.
Change can be confusing and stressful. For rare disease patients who need consistent access to medical treatment, changing providers, payers or both can cause even more stress than usual. Specialty pharmacies can alleviate some of this stress by offering a consistent point of reference through times of change.
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