The Great Escape: 5 Keys to Unlocking Specialty Medication Barriers

For more than 8 million people in the U.S. living with psoriatic disease, biologics promise improved symptom management and slower disease progression. However, for many, gaining access to needed therapies is like being trapped in healthcare’s most frustrating escape room. Barriers to specialty medications begin the moment the doctor starts the prescribing process. 

Psoriasis Action Month, which takes place every August, is a reminder that this scenario plays out all too often. Here are some ways that end-to-end engagement technology solves those challenges:

1. Unlock Specialty Medication Barriers by Simplifying Prior Authorization

Prior authorization (PA) is often the first barrier patients encounter for specialty medication access. It’s needed in 71% of cases for infused rheumatologic medications, with 21% initially denied, leading to treatment delays of two weeks or longer.   

Solution: Give providers PA insights directly within the EHR workflow. For example, an alert that an ICD-10 code is needed for a specific medication’s PA—and may even fulfill the PA so no further documentation is required—can shorten the time it takes to get a patient started on therapy.

2. Ensure Prescriptions Reach the Right Destination

Navigating prescribing requirements for specialty medications is another challenge providers and patients encounter. For example, a physician may select the patient’s preferred retail pharmacy by default, unaware that the prescribed therapy has a  limited distribution network and needs to be sent to a specific pharmacy or it can’t be filled.

Solution: Specialty medication coordination integrated directly in the EHR workflow keeps prescribers informed about the fastest path to fulfillment, including whether the prescription needs to be routed to a specialty pharmacy or limited distribution network.   

3. Solve Cost Challenges Before They Block Access

Financial barriers are some of the most difficult puzzles patients face. Nearly half (46%) of Medicare patients diagnosed with psoriasis abandon biologic therapy within one year, with cost being a significant driver. For some patients, the cost is simply too high to start treatment.  

Solution: Send patients a text message with cost-saving resources moments after the prescription is written. Automate provider-patient messaging so patients can receive copay cards or enroll in support programs right from their smartphone, rather than get stuck waiting for help they didn’t know existed. 

4. Address Patient Concerns to Build Trust

Some barriers are internal. Patients may worry about side effects or be uncomfortable with the idea of injections or infusions. These unspoken concerns often lead them to abandon therapy.  

Solution: Proactively address common concerns by sharing patient-friendly education. By sending a text link to materials that clarify the “why” behind each treatment, you boost patients’ confidence and trust in the therapy. Building this foundation early helps unlock better engagement and adherence. 

5. Prevent Therapy Disruptions 

Even after patients start treatment, new obstacles can appear. Formulary changes or reauthorization requirements can get in the way of ongoing adherence. So can forgetfulness. Even unforeseen events can influence adherence. During the COVID-19 pandemic, over 30% of patients with psoriasis faced treatment disruptions due to access challenges. 

Solution: Support ongoing adherence with well-timed, SMS text nudges reminding patients to renew prescriptions to avoid disruptions in ongoing therapy. 

Ready to Beat Specialty Medication Barriers?  

Specialty medication barriers are more than frustrating—they’re clinically significant. Medication delays and nonadherence can lead to serious complications, including hospital admissions for uncontrolled symptoms.  

Adherence and persistence rates for widely used therapies like etanercept, adalimumab, and infliximab typically range between 50% and 60%, indicating a need keep patients engaged and informed to keep therapy on track. 

Pharmaceutical companies play a pivotal role in unlocking specialty medication barriers. Using an end-to-end engagement platform, you can deliver messages at critical moments throughout the prescribing and onboarding process, helping patients access therapies that improve health outcomes.  

Next step: Want to learn how Timely by DrFirst breaks through specialty medication barriers? Check out this success story for an injectable biologic.