Medication access barriers ranging from burdensome prior authorization processes to poor communication among care teams have plagued the healthcare industry. However, with the right coordination and technical support, providers can tackle these issues and streamline the medication process for patients.
Cited as one of the biggest frustrations for prescribers, prior authorization processes have become increasingly burdensome for clinicians, according to the American Medical Association. Most physicians (86 percent) believe that their workload associated with PA is high or extremely high, while 88 percent say the burden has increased in the last five years.
During a Feb. 5 webinar hosted by Becker's Hospital Review and sponsored by CoverMyMeds, Dustin Eubanks, director of business development at CoverMyMeds, discussed the top barriers to medication access and the solutions healthcare organizations can implement to address these issues.
Prior authorization
As a direct response to the clinical complexity of PAs, work associated with the process is beginning to shift to medical assistants, nurses and PA specialists. Mr. Eubanks offered the example of a gastroenterology nurse at an organization that has partnered with CoverMyMeds. Prior to the partnership, the burden of PA had been transferred to the nurse who was stepping in and covering the process so the physician could spend more time with patients.
"The nurse [was] being asked to become an expert, or a PA guru, to help navigate this process," Mr. Eubanks said. "But by doing so, she would feel more like a ward clerk than a traditional nurse who is focusing on face time with patients."
To help dissolve PA burdens among the care team, health systems should delegate and coordinate PA responsibilities so patients can get quicker access to their medication therapy.
Lack of price and/or benefit transparency
Seventy-five percent of healthcare providers said a patient's out-of-pocket medication cost is rarely or never available to them at the point of prescribing, according to a 2020 CoverMyMeds survey. Further, only 10 percent of providers said they were able to access prescription pricing information within their EHR. This lack of data access can prevent providers from incorporating their patients' financial situation into the prescription equation and limits patients from participating in the prescription process.
When a provider writes a prescription, information on formulary and benefit coverage, patient assistance, pharmacy cost and cash price options, as well as alternative medications are rarely available in the EHR.
"It goes without saying that the formulary benefit has done some injustice to the market by not making patient-centered decisions and not knowing plan-level information," Mr. Eubanks said. "It's created a little bit of distrust and a rift between the prescriber, the centralized team, the pharmacist and patient."
Delayed communication
A disconnect among the care team, whether caused by the PA process or a lack of information at the point of prescribing, can result in patients feeling neglected. As providers spend more time than ever navigating health insurance issues, they are continually pulled away from face-to-face interactions with patients. Providers cited reduced face-to-face time as the top result of time dedicated to health insurance-related activities, according to a 2019 CoverMyMeds provider survey.
Similar to the gastroenterology nurse, there are clinicians who want to step in and help patients by alleviating PA burden and getting them easier access to their medication therapy. However, these clinicians often lack all the necessary prescribing information to advocate for the patient when the pharmacy contacts the provider for PA submission.
Social determinants of health
To support patients' health, providers must understand and account for social and physical barriers in treatment plans. These barriers, or social determinants of health, can include access to health services, physical environments, employment and working conditions, and income.
These social determinants are indicative of a patient's resources and overall health. Understanding these determinants is essential for creating a more comprehensive medication therapy process. In the context of medication access, social determinants can be displayed as transportation to a patient's preferred pharmacy, access to coupons or vouchers and medication affordability.
"We need all the [social determinants data] inputs in order to make an informed decision and provide the right guidance," Mr. Eubanks said. "[By doing this, we can be a] good advocate and match the right answer to the right patient based upon what they need."
Uniting the care team
Today's modern care team has moved beyond just the provider; it now includes the pharmacy, payers and the patients themselves. These team members all have one common goal: improving the life of the patient. This goal can be achieved by increasing collaboration to get patients the medication they require.
Uniting providers, pharmacy and payers to deliver a more patient-centric approach to prescribing can help streamline the PA process, foster transparency, reduce communication barriers at the point of prescription, and ultimately give patients quicker and more robust access to medications.
To view the full webinar, click here.