Patient adherence to specialty medications is crucial for successful treatment outcomes, yet it remains a significant challenge. From the high cost of medications to the laborious enrollment processes, patients face numerous barriers that can hinder their adherence to prescribed therapy regimens.

In this blog, we will dive into various factors contributing to non-adherence and explore how RxLightning can help overcome these challenges.

Medication Cost

The number one factor in medication non-adherence is typically cost. Studies have shown that slight increases in patient responsibility, even as little $10, can decrease medication adherence as much as 10%. This frightening statistic is only exacerbated when medication costs reach the thousands or tens of thousands of dollars.

Unfortunately, there are multiple hurdles when thinking about medication costs. First, there is often no upfront transparency into the cost of the medication being prescribed. In these situations, a patient is instructed to visit a pharmacy, infusion center, or clinic to receive their medication – and are blindsided with the exorbitant cost. These surprises prevent effective planning and financial aid discussions, which leads to unexpected non-adherence.

Even if cost is presented early in the patient’s health journey, many simply cannot afford the out-of-pocket expense, leading them to skip doses or forego treatment altogether. Despite over 90% of the US population having some form of health insurance, the increase in high-deductible plans and cost sharing means that patient responsibility is often in the thousands. It is reported that between 20% and 35% of the population do not have enough savings to meet their deductible or out-of-pocket maximums (Health System Tracker). This can have disastrous effects on a patient’s wellbeing, including leading to ongoing medical debt and insurance difficulties.

Enrollment Processes

Beyond cost, the enrollment process for specialty medications can be complex and time-consuming, requiring patients to navigate multiple forms, paperwork, and approvals. This arduous process often leads to frustration and delays in accessing vital medications. In order to start a medication, patients and their care teams may have to complete and send dozens of paper forms (via fax), collect signatures from various stakeholders, research insurance coverage details, find a convenient pharmacy, and more.

Whether enrollments are delivered to manufacturers, hubs, or pharmacies, additional communication and paperwork is often needed to enable medication dispensation. Lack of digital processes, error-prone forms, phone calls between stakeholders, lack of visibility… the list of obstacles is never-ending and can slow the onboarding process to a point where the patient decides to forego treatment altogether.

Hurdles in Onboarding and Insurance Approval

The insurance approval process is typically included in the enrollment workflow, but it is worth discussing separately due to the many steps that it requires. First, the patient’s care team must identify which insurance carrier and plan the patient is a member of. This is sometimes simple, but patients often lose track of their insurance card, are unaware of changing benefits, or simply don’t realize costs will be incurred even though they have insurance. Explaining these details and confirming plan specifics takes time.

From there, the insurance company will typically require prior authorization (plus additional signatures and paperwork) to approve the drug. This can take anywhere from days to weeks.  Navigating through the maze of required documentation and insurance approvals can pose significant challenges for patients, impeding their ability to start treatment in a timely manner.

Removing Barriers to Solve for Medication Adherence

At RxLightning, we understand the critical importance of patient adherence to specialty medications. That’s why we’ve developed a comprehensive solution to address the barriers that hinder adherence while streamlining specialty medication access and affordability. Key components of our platform include:

  • Insight into Medication Costs: Through our platform, we offer transparency into the cost of medications and affordability options to help patients access vital treatments. RxLightning leverages Real-Time Benefit Check integrations to display patient cost at the point of care, directly from insurance carrier networks. This allows patients and care teams to understand cost upfront, and decide how to best proceed. Depending on the medication prescribed, RxLightning also provides options for copay assistance and free-drug programs (supplied by the manufacturer) as well as foundation grant funds for over 400 disease states – all of which can support patients as they navigate affordability challenges. Learn more about ways to simplify patient affordability in our recent blog.
  • Digital Enrollment Processes: Digital forms and submission processes accelerate the time it takes to submit an enrollment, eliminate paperwork chasing and missing info, and create a consistent submission experience for both patients and providers. With RxLightning, stakeholders can quickly and efficiently submit enrollments to PAP, hub/patient support services, and pharmacies – for all manufacturers and brands – without having to download a form or fax paperwork. These digital processes reduce administrative burden and expedite the approval/dispensation of specialty medications.
  • Real-Time Benefit Checks and Expedited Prior Authorization Clearance: With integrations to check patient benefits, confirm coverage, and initiate prior authorization, RxLightning simplifies the steps needed to ensure timely access to medications. Completing manual benefit confirmations via phone and jumping between platforms for prior authorization both delay care and increase frustration for care teams. Fortunately, fully-integrated capabilities can eliminate the need for multiple portals and listening to dreaded hold music.
  • Patient Consent Collection: RxLightning’s proprietary consent collection capabilities – which allow signature collection via in-office signing, email, or SMS – enable manufacturer and patient services outreach to support patients throughout their care journey. As written in our recent blog, collecting patient signatures can ensure enrollment success and ongoing medication adherence.
  • Real-Time Status Updates: Providing visibility and accountability throughout the medication access journey is an essential step in medication adherence. RxLightning provides portal access to patients, providers, manufacturers, hubs, pharmacies, field reimbursement managers, and more – with the goal of creating complete transparency into the medication journey, and identifying any hurdles that need to be overcome. With a common goal in mind, stakeholders can support patients in initiating and adhering to their medication regimen.

By leveraging RxLightning’s innovative platform, healthcare providers and patients are empowered to overcome barriers to adherence and achieve better treatment outcomes.

Together, we can ensure that every patient has access to the specialty medications they need to live healthier, happier lives. To learn more about how RxLightning can help improve patient adherence to specialty medications, please reach out today.