In today’s rapidly evolving healthcare landscape, health system pharmacy teams are forced to balance competing priorities, including everything from creating operational efficiencies to generating revenue for their health systems and providing high-quality care to patients.
Unfortunately, the traditional, paper-based processes that teams typically leverage for specialty medication enrollment not only lead to delays in care, but also contribute to avoidable labor costs, poor adherence/outcomes, and revenue leakage. In this blog, we will dissect some of the critical challenges that health systems are tackling, and how innovative technologies can empower pharmacies to streamline specialty medication enrollment, improve patient access, and drive meaningful growth.
Labor Costs and Enrollment Inefficiencies
Health systems often grapple with the challenge of managing labor costs and inefficiencies within their pharmacy operations. Manual, paper-based processes (i.e. finding and completing paper forms, faxing forms to manufacturers or hubs, confirming patient benefit information, collecting consent, etc.) require significant time and resources to complete, leading to bottlenecks and delays in patient care. Additionally, tracking patient enrollments, their statuses, and manufacturer communications is incredibly cumbersome, with various portals and websites requiring unique log-ins in order to proceed. In the time it takes to successfully enroll a patient on a specialty medication, pharmacy staff could contribute much more meaningfully to patient care, such as providing patient counseling or medication management services.
Innovative technologies – like the solution RxLightning has developed – automate and streamline pharmacy processes. A single portal can be leveraged to find and complete 1,600+ medication enrollment forms, with one familiar workflow regardless of the destination – manufacturer, hub, pharmacy, foundation, etc. Required form fields eliminate back-and-forth calls, while integrations for Real-Time Benefit Check and prior authorization expedite enrollment completion and fulfillment. Embedded affordability options and digital consent collection also reduce downstream delays in therapy initiation.
By eliminating data entry and fax, while optimizing enrollment processes through the use of comprehensive medication access technology, pharmacies and medication assistance teams can increase productivity, reduce labor costs, and accelerate patient access to care.
Pharmacy Leakage and Revenue Growth
For health systems with specialty pharmacies, prescription leakage can present a significant challenge to financial sustainability. Leakage occurs when prescriptions are filled outside of the health system’s pharmacy network, resulting in lost revenue opportunities and fragmented patient care. Additionally, free-drug programs can cause unsustainable fulfillment and bad debt, as scripts are being offered to patients without revenue coming in the door.
Unfortunately, leakage and bad debt can be caused by upstream processes and opaqueness in viable payment options. For example, a medication access team may select a Patient Assistance or Free Drug program (to be filled within or outside of the health system), without completing a search for a grant or foundation that would enable immediate payment for the drug.
Technology can play a critical role in surfacing foundation/grant options and maximizing pharmacy revenue opportunities. RxLightning accesses a robust network of foundation partners, covering over 400 disease states, enabling a simple search to find and enroll in available support. By matching patients to open foundations – or creating notifications for when foundations have available funds – medication access teams can support patient affordability, prioritize foundation options for those who are eligible, and keep (or redirect) scripts to in-house pharmacies.
Patient Adherence, Access, and Affordability
Operational effectiveness and revenue growth are key priorities for pharmacies, but patient care should never be deprioritized. Outcomes are often dependent on several critical factors, including adherence to a therapy regimen, medication cost, and resources to support patients throughout onboarding. Unfortunately, with the prevalence of complex and high-cost specialty pharmaceuticals in recent years, patients have become accustomed to burdensome enrollment processes and delays in care.
In order to better support patients, care teams must have access to Real-Time Benefit Check technologies to understand patient out-of-pocket costs, and leverage digital tools to find PAP, copay assistance, or foundation grant programs. The combination of these options – especially when embedded within one solution – can dramatically increase the likelihood of finding affordable care and increasing patient adherence.
Further, technology-enabled enrollment workflows can significantly accelerate insurance approval, manufacturer approval, and ultimately, pharmacy fulfillment. By eliminating phone and fax, providing all required information on forms, and submitting enrollments digitally, patients can be free from endless care delays, and be on the path to improved health more quickly than ever before.
Lastly, digital consent collection enables additional support for patients who require assistance. By collecting patient opt-ins, manufacturer hub and field teams can engage directly with patients to support ongoing adherence through medication education and programs.
Evolving Your Pharmacy Business
The demands put on health systems and pharmacies to better manage costs, drive revenues, and improve patient outcomes requires a new approach. Not only is it essential that pharmacy leaders think more holistically about the technologies their teams leverage to streamline medication enrollment workflows, but they must also balance revenue growth, as it is an essential metric that can decide the fate of a pharmacy’s success.
RxLightning works with health systems, pharmacies, and medication access teams to deploy solutions that solve all of these critical challenges. By digitizing enrollment forms and providing integrations for benefit checks and PA, health systems can accelerate onboarding processes; while visibility into affordability options and digital consent capture can drive ongoing patient adherence and pharmacy capture.
By embracing innovative technology solutions, health systems can revolutionize their business outcomes, ensuring a seamless and efficient experience for both patients and providers. To learn more about the ways RxLightning can support your pharmacy growth, please reach out today.
