Digital Transformation and Innovation Leaders deeply understand the power of technology and how it can be used to revolutionize patient care and business practices. While significant advancements have been made in healthcare across the last 50 years, one area is still ripe for innovation: specialty pharmacy.

Current challenges in this space – including paper-based processes, lack of visibility into affordability options, and enrollment complexity – lead to non-adherence, leakage, and increased labor costs. However, there is a better way. Leveraging digital solutions can transform inefficiencies into streamlined, effective workflows that enhance patient care, reduce administrative burden, and increase pharmacy revenues.

The Current State of Specialty Medication Access 

Specialty medications are touted as life-saving treatments for patients with complex health conditions. However, the journey to access these medications is fraught with obstacles.

While a typical prescription is ordered and picked up at a retail pharmacy, a specialty medication is nowhere near as simple. Enrollment paperwork custom to each drug/manufacturer must be completed by the provider (or their team) and signed. Additional patient signatures, insurance details, and approvals are often required to enroll patients in manufacturer/hub support services, which improve the likelihood of fulfillment. Furthermore, paper, phone, and fax are still common throughout these workflows, causing delays, administrative burden, and security concerns. These non-digital, byzantine processes frustrate care teams and patients alike.

Even more worrying is that a lack of visibility into affordability options can cause non-adherence and prescription leakage. In cases when a patient needs financial assistance to afford their medication, a member of the care team must sift through foundations and patient assistance programs as quickly as possible to ensure therapy initiation. They are often blind to options that would enable them to fill the script immediately within their own health system pharmacy network.

When a staff member misses one field on a form, the paperwork must be resubmitted. When insurance information is not readily available, someone must call the payer to confirm coverage. When a patient needs two or more specialty medications, a team member must visit various manufacturer websites to find and submit documentation. It’s time to innovate.

Specialty Pharmacy is Ripe for Innovation 

The fax machine was invented in 1964, but your processes shouldn’t be dependent on technology from that time. 

New digital solutions can automate and streamline specialty medication enrollment workflows, reducing your team’s reliance on paper forms and manual data entry (with EHR integrations further eliminating duplicate work). Required fields on digital forms, APIs to connect to partner systems, and HIPAA-compliant signature collection lead to faster, more accurate processing of medication enrollments and insurance approvals. 

Further, visibility into affordability options supports patients, providers, and pharmacies throughout the medication access journey. Real-Time Benefit Check highlights patient out-of-pocket costs, while integrations for copay cards, Patient Assistance Programs, and open foundations surface lowest-cost options that enable prescription fills within the health system network. By automatically matching patients to available financial assistance programs, health systems can identify options that reduce bad debt and drive pharmacy capture.

As the volume of specialty medication orders continues to rise, it is increasingly important that teams leverage modern technology to accelerate submission speeds and improve patient access.

Making Innovation a Reality

RxLightning offers a comprehensive platform designed to address access and affordability challenges. Health systems across the country leverage key RxLightning components:

  • Digital Enrollment: Repeatable, paperless workflows for 1,600+ specialty medications, which accelerate medication submissions/approvals, reduce labor costs, and improve speed-to-fill.
  • Real-Time Affordability Options: Identification of foundation, grant, and copay assistance programs (in one portal) ensures patients receive the financial help they need, while maximizing pharmacy capture and revenue.
  • Integrations to Eliminate Portal Fatigue: A one-stop-shop for Real-Time Benefit Check, prior authorization initiation, enrollment submission, consent collection, financial support, and more.
  • Secure, Web-Based Access: The HITRUST-certified portal provides enhanced visibility into the medication access journey for patients, providers, care teams, manufacturers, hubs, and pharmacies – allowing for better coordination and superior patient onboarding experiences. 

As RxLightning Founder and CEO, Julia Regan, said in a recent interview, “Many people have tried to fix the slow, manual specialty medication onboarding process, but they’ve approached it with a single drug, pharmacy, or isolated part of the process in mind. RxLightning is the first to provide an end-to-end solution that covers the entire market – from every medication and destination to every stakeholder in the process.” 

What Are You Waiting For? It’s Time to Innovate.

As clinical and operational workflows continue to evolve, it is crucial to address the challenges associated with specialty pharmacy and medication access. By embracing digital solutions, you can improve patient outcomes, reduce administrative burden, and enhance financial performance. RxLightning is committed to supporting health systems in their journey to transform the specialty medication onboarding experience from start to finish. 

Join us in revolutionizing specialty medication access. For more information, please contact our team today.