Specialty Medication Barriers to IBD Patient Access (And How Pharma Brands Can Fix Them)

This Crohn’s and Colitis Awareness Week, three million Americans with inflammatory bowel disease (IBD) need more than clever hashtags. They need a smoother path to start and stay on prescribed therapies.

Consider this situation: A patient has managed moderate Crohn’s disease with conventional therapy for several years when her symptoms worsen. Her gastroenterologist recommends a promising biologic, and she leaves the appointment feeling hopeful. Finally, a treatment that could help her feel like herself again.

Then come the specialty medication barriers. The prescription needs prior authorization. The specialty pharmacy needs specific documentation. The patient’s insurance plan has changed its formulary, requiring a switch to a different biologic than originally prescribed. Weeks later, still waiting for approval while managing painful flare-ups with prednisone, she finds herself wondering whether the medication is worth starting. Patients diagnosed with IBD know this experience all too well.

Specialty Medication Barriers and Friction

Coordinating access to prescribed therapies across providers, pharmacies, payers, and patient support teams—each with different timelines and processes—too often delays care.

Upstream Uncertainty  

When data doesn’t flow freely between these stakeholders’ systems, providers are burdened by both administrative and cognitive overload. They don’t need additional friction in their workflow, like: 

• Tracking formulary variations
• Determining prior authorization (PA) requirements
• Calculating patients’ out-of-pocket prescription costs
• Identifying financial support resources  

A multicenter U.S. study published in The American Journal of Gastroenterology found the average time from prescription to first dose for adult patients with IBD was 25 days, with less than half receiving medications within 14 days. During this window, patients wait for: 

• Benefits verification
• Prior authorization submission and review
• Specialty pharmacy coordination
• Patient assistance program enrollment 

While these steps exist to ensure appropriate utilization and manage costs, they can also cause providers to avoid specific therapies—not because they’re ineffective, but because they require a heavy administrative lift. A nationwide provider survey published in Clinical Gastroenterology and Hepatology revealed that gastroenterologists changed 48% of biologic prescriptions before placing the order because they expected it would be hard for patients to get the medication.

Lack of Engagement

Delays due to cumbersome processes impact patients as well. Fail-first step therapies can slow access to medications that could offer greater relief from IBD symptoms. Even after a PA is approved, affordability can be a blocker to that first fill if the patient isn’t aware of copay cards or other patient support programs.  

Research published in Inflammatory Bowel Diseases found that 63% of patients diagnosed with IBD reported cost barriers for their prescribed therapies, resulting in:

• Therapy delays
• Switching to less expensive alternatives
• Rationing IBD medications rather than taking them as prescribed
• Not filling the prescription at all 

The research also indicated that affordability barriers continued beyond the first fill, with less than half of patients staying on the prescribed biologic after one year due to cost. 

Occasionally, patients intend to pick up the medication but have second thoughts based on social scuttlebutt (not real-world evidence) or because they get busy and simply forget.  

For pharmaceutical brands, this common scenario represents both patient care gaps and a commercial challenge. But it also signals a strategic opportunity because specialty medication barriers create friction at predictable points in the medication journey. Addressing these barriers through proactive engagement strategies improves patient adherence while generating real-world evidence that demonstrates value to payers.

The End-to-End Engagement Imperative 

Addressing specialty medication barriers requires strategies that serve multiple objectives simultaneously. The most effective programs deliver value across pharmaceutical brand marketing, patient support, and market access teams. 

Brand Marketing: Turning Awareness Into Action 

Traditional awareness campaigns drive prescriptions, but specialty medication barriers prevent conversion. First-fill rates determine campaign ROI more than prescription volume. Competitor differentiation increasingly depends on patient experience, not just clinical data. 

Smart brands embed useful information directly into provider EHR workflows at the point of prescribing, such as:  

• Automatic alerts for new indications and expanded access programs
• Formulary status and PA requirements such as including an ICD-10 diagnosis code
• Financial assistance resources based on patients’ benefits verification and cost calculation 

This yields strategic benefits, including:  

• Less provider friction and stronger brand positioning as a partner in patient access
• Higher provider satisfaction with support tools, positively impacting future prescribing patterns 

Patient Support Programs: Outreach Timed For Success 

Most patient support programs or third-party hub services engage patients after pharmacy submission, which can be days or weeks after the prescription is written. By then, patient motivation has declined, and barriers have accumulated.  

However, with personalized patient engagement, program managers can activate patients moments after a prescription is written. Text messages sent on behalf of patients’ trusted providers address common barriers, offering:  

• Educational resources for the prescribed therapy
• Copay cards or streamlined hub and patient support services enrollment
• Tap-to-call guidance from nurse navigators or other support resources
• Well-timed nudges for refill support and ongoing adherence 

Patient support program managers can take advantage of proactive, end-to-end engagement to:  

• Capture patients at peak motivation, improving first-fill conversion
• Identify barriers for proactive intervention before disruption occurs
• Maintain high engagement throughout the therapy lifecycle 

Market Access: Building Evidence That Informs Formulary Decisions 

Prior authorization requirements often reflect payer uncertainty about real-world utilization and outcomes.  As a result, payers increasingly require real-world evidence (RWE) alongside clinical trial data for formulary decisions. Demonstrating value requires evidence of adherence, persistence, and effectiveness in diverse populations. 

Here’s where improving patient adherence creates strategic leverage: Smooth onboarding and sustained adherence generate high-quality, real-world evidence automatically. Every successfully onboarded patient and completed refill becomes data showing value. Research confirms that RWE helps accelerate formulary decisions for biologics. 

This creates measurable market access advantages, including: 

• Strong real-world adherence data supports requests for preferred formulary status
• Demonstrated effectiveness across patient populations may simplify or reduce PA requirements over time
• Robust persistence data enables value-based contracting discussions 

It’s a positive cycle: Better patient support leads to better adherence, which generates better real-world evidence, which improves market access, which makes it easier for patients to start and stay on therapy.

Why Siloed Approaches Underperform 

When brand, patient support, and market access programs run in isolation, each misses critical opportunities, such as:

• Brand campaigns drive awareness but don’t address access barriers.
• Patient support programs engage too late in the journey.
• Market access teams lack real-world data to prove value. 

All three functions can benefit from a unified engagement platform.

Breaking Down Specialty Medication Barriers to Benefit Everyone 

This Crohn’s and Colitis Awareness Week, pharmaceutical brands have an opportunity to move beyond awareness. Specialty medication barriers are well-documented, but they can be solved. 

Improving patient adherence requires proactive engagement at multiple touchpoints—before, during, and after prescribing. The benefits extend across stakeholders:

• Patients gain faster access, better support, and improved outcomes. 

• Providers experience less cognitive load, smooth workflows, and better tools. 

• Payers receive real-world evidence demonstrating value and appropriate utilization. 

• Pharmaceutical brands achieve higher persistence, competitive differentiation, and robust data for market access discussions. 

Timely^SM by DrFirst^® enables pharmaceutical brands to transform specialty medication barriers into engagement opportunities. Through EHR-integrated provider support and patient engagement at critical moments, Timely delivers proactive, end-to-end engagement that reduces cognitive and administrative burdens for providers, improves patient adherence, and generates real-world evidence that shows value to payers. These programs serve brand marketing, patient support, and market access goals simultaneously. The result: better patient outcomes and stronger competitive positioning.

Ready to improve patient adherence by defeating specialty medication barriers? Learn how Timely can positively impact the medication journey from prescribing to adherence.