Incomplete Patient Data Delays Prior Authorization for Specialty Medications

Nearly two-thirds of prescribers report that inaccurate and incomplete patient data is a top challenge to obtaining prior authorization for specialty medications, according to a new Surescripts survey conducted by APCO Insight.

Additionally, 82 percent of specialty prescribers and 87 percent of specialty pharmacists agreed that starting patients on a specialty medication should take less time.

"Imagine being told by your doctor that the health condition you've been diagnosed with requires a specialty medication, but you might not be able to start treatment for up to a month due to the outdated process and paperwork required for prior authorization," Cecelia Byers, PharmD, clinical product advisor for specialty at Surescripts, noted in a press release.

"There is a natural sense of urgency to want to begin treatment right away for both providers and patients," Byers added. "The technology available today can help to close the gaps in patient health information, speeding up the time it takes from a patient's initial diagnosis to starting treatment with specialty medications."

Specialty medications made up most new medications introduced in the past five years, according to an IQVIA Institute report. These therapies require providers to collect more detailed patient information through an outdated, manual administrative process before a patient can begin treatment.

"Simplifying the process of specialty prescribing and closing the gaps in patient information is one way to eliminate the burdensome administrative tasks that can take a providers' attention away from their patients," said Frank Harvey, Surescripts CEO.

"This clinical intelligence also helps patients start treatments faster, improving their care journey and allows pharmacists and prescribers to shift their focus back to their most essential responsibility of delivering quality care to their patients," Harvey continued.

More than 80 percent of specialty prescribers and pharmacists say it should take two weeks or less to get a patient started on a new specialty therapy. However, 70 to 80 percent say it takes three to four weeks.

Delayed or denied approvals among prescribers of specialty medications are the most challenging day-to-day job responsibility. Almost all specialty pharmacists surveyed agree that patient-specific benefit information would help them and their teams get patients started on a new specialty therapy.

More prescribers and specialty pharmacists nationwide are leveraging Surescripts Specialty Medications health IT to optimize prescribing workflows.

From May 2021 to May 2022, the number of prescribers enabled for Specialty Patient Enrollment grew 24 percent.

Additionally, the number of Specialty Medications Gateway transactions was 421 percent higher in the first five months of 2022 than in 2021.