The scenario is familiar and frustrating for pharma teams: Your specialty medication is prescribed, approved, and filled, but the patient still doesn’t pick it up from the pharmacy.
The breakdown can happen early, inside the specialty prescribing workflow, in the moments between the physician’s decision and the prescription reaching the right pharmacy. That’s the territory two experienced physicians explored in a recent webinar hosted by Fierce Pharma.
Michael Blackman, M.D., Chief Medical Officer of Greenway Health, and Colin Banas, M.D., M.H.A., Chief Medical Officer of Timely by DrFirst, have spent their careers at the intersection of clinical practice and the systems physicians use every day. Their conversation offers a physician perspective on specialty prescribing friction and the implications for pharma.
Watch the full webinar now or see the highlights below.
Dr. Banas explains that when prescribing a specialty medication, physicians are asked to play a game without being told the rules—and the rules change with every prescription.
A physician writing a specialty prescription may not know which pharmacy can fill it, what circumstances trigger a prior authorization, or whether a patient assistance program exists to offset the cost. And when the prescription is sent to a pharmacy that can’t fill it, the burden of fixing it falls on clinical staff who are already stretched thin.
For market access and patient support teams, this is the part of the patient journey that your strategies often don’t consider.
Dr. Blackman offers the perspective that EHRs have traditionally recorded care rather than actively managing it. With AI and real-time data, there is an opportunity to close that gap.
If the prescribing workflow can surface information such as financial assistance, specialty pharmacy options, and PA requirements at the plan level, the access gap shrinks before your patient support team has to intervene.
When 94% of physicians say that the prior authorization process delays necessary patient care, the challenges go beyond administrative inconvenience and become a clinical problem.
The burden of moving prescriptions through the PA process is consuming staff capacity that most practices don’t have to spare. Even worse, many patients simply give up when faced with delays and uncertainty.
The proposed CMS rules Dr. Banas and Dr. Blackman discuss (including CMS-0062, which would mandate digital standards and timelines for prescription prior authorization) signals that regulatory pressure is coming. For pharma teams thinking about access strategy, understanding what that shift means for prescriber behavior is worth getting ahead of now.
The good news is that both CMOs are optimistic. Dr. Banas walks through two concrete examples of what intelligent workflow support looks like when it’s done right.
Within the prescribing workflow, the prescriber can be told which pharmacies are able to fill a specialty prescription, helping avoid re-routing from a pharmacy that can’t fill it. A suggestion to include the diagnosis code may satisfy the PA process before it starts. Neither requires a physician to learn a new system, and both reduce friction without adding clicks.
For patient support programs and hub services, this is the upstream moment your teams rarely get to touch. With PA groundwork already laid, the downstream process gets easier.
Drs. Banas and Blackman cover a lot of ground in this webinar, from patient confusion and sticker shock to the regulatory landscape to where AI fits into the future of medication management. If you work in brand management, market access, or patient support and you want a physician’s-eye view of where the specialty prescribing workflow breaks down, this conversation is worth your time.
If you’re ready to see how Timely by DrFirst can reduce prescribing friction for your brands, let’s talk! Schedule a demo.