When specialty medications fail to reach patients, a common reaction is to ask: Did the patient understand their benefits? Did they receive financial support? Did the pharmacy follow up?
Those are good questions, but they’re often asked too late. The more consequential question comes earlier: Was the prescription written with everything it needed to be filled?
As the specialty medication pipeline has exploded, prescribing complexity has also increased. Roughly 75% of the approximately 7,000 drugs currently in development qualify as specialty medications, and prescribing these drugs requires providers to navigate a maze of payer-specific criteria like quantity limits, number of refills, and diagnosis code requirements. A mismatch or gap in any of those details can flag the prescription at the pharmacy, stall the process, and put the patient in a holding pattern with no visibility into why.
For market access teams and patient support managers, these upstream challenges drive abandonment in ways that downstream intervention alone can’t fix.
PharmaShots recently interviewed Colin Banas, M.D., M.H.A., Chief Medical Officer of Timely by DrFirst, about the delays, prescription abandonment, and poor patient outcomes that result from prescribing friction.
“Existing e-prescribing workflows weren’t built for specialty medications,” Dr. Banas says. “Clinicians get stuck in a cycle of rework: the prescription is sent, the pharmacy calls back to resolve an issue, the doctor’s staff scrambles, and the patient waits.”
That cycle, which Dr. Banas calls “prescription ping-pong,” erodes patient momentum. “For many of these therapies, days can be clinically consequential,” he notes. “Getting the prescription right upstream is critical so it doesn’t cause delays and rework downstream.”
Understanding the scale of this problem requires understanding what’s being asked of prescribers. In a typical visit, the provider assesses the patient, reviews medication history, documents in the electronic health record (EHR) system, and navigates payer criteria, prior authorization requirements, limited distribution logistics, and financial assistance options.
“Physicians are being asked to play a game they don’t know the rules to,” Dr. Banas says. The result: Prescriptions leave the office with gaps that trigger prior authorization reviews and pharmacy change requests, and patients arrive at the pharmacy only to discover their out-of-pocket cost is unmanageable.
After a provider selects a medication, the Timely by DrFirst platform surfaces real-time intelligence, such as individual benefits verification and prior authorization criteria, that helps the provider choose the next best action in the prescribing workflow.
The analogy Dr. Banas uses is GPS: “After you select your destination, the system guides you so you can arrive as quickly as possible without unexpected delays and detours. But you decide the route.” The prescriber remains in control, while the platform removes the obstacles they didn’t know were there.
An internal review of Timely by DrFirst pilot programs found a 60% prior authorization completion rate when Timely asked the provider one to three targeted questions specific to the patient and the drug. Other pilots showed that actionable support in the provider workflow resulted in 56% fewer pharmacy change requests for drugs that commonly trigger follow-up.
As soon as the prescription is sent, an automated text message on behalf of the provider continues to support the medication journey by informing patients about their new medication, unlocking savings opportunities to reduce out-of-pocket costs, and guiding enrollment into support programs, making therapies more accessible and affordable.
For market access teams and patient support managers, the implication is significant: If your engagement strategy begins at the pharmacy or after a PA is submitted, you’re already operating in recovery mode.
The friction that causes patients to disengage (the waiting, the confusion, the unexpected costs) often originates in the prescribing workflow, before your programs have a chance to engage. By addressing issues upstream, prescriptions arrive at the pharmacy ready to fill and the patient leaves the office informed and prepared.
Dr. Banas asks, “What if we got all the nuance of the script correct before hitting ‘send’ so none of the back-and-forth had to happen?”
That’s a question worth reading more about. See the full interview in PharmaShots: Ending Prescription Ping-Pong in Specialty Care.