Friday, May 02, 2014

Fixing the Patient Non-Adherence Epidemic in the Specialty Drug Market

Today’s guest post comes from Scott Pribyl, CEO of mRx Ventures. He describes SamplifyRx, a cloud-based hub and virtual marketplace of patient support services that manages every touch-point in the specialty drug workflow process.

Scott will be at the Armada Specialty Pharmacy Summit & Expo. To learn more about his intriguing software platform, email him at scott@samplifyrx.com or connect via his Armada Summit profile page.

Worthwhile article. Check it out.

Fixing the Patient Non-Adherence Epidemic in the Specialty Drug Market
A virtual marketplace for specialty samples, copay cards and patient services
By Scott Pribyl, mRx Ventures

According to Express Scripts’ Insights report, patient non-adherence is a $317 billion epidemic (source) where 31% of the patients cannot afford the prescribed medication due to financial burden (source).

I saw the impact personally seven years ago when I walked into a rheumatology office and saw first-hand the devastating impact of a rheumatoid arthritis patient not receiving any patient support. The elderly patient had been paying full price for his biologic medication and it wiped out his 60 years of life’s savings. The most frustrating thing was it didn’t have to be this way. He had stopped his medication because he couldn’t afford it and now he was officially non-adherent.

Specialty drug manufacturers offer a comprehensive suite of services – copay cards, sample programs and nurse injection training to name a few - so no patient will be left behind. But specialty drugs are different, and programs like sample closets, simply copied from those of traditional drugs, don’t readily apply. Because of their expense and complexity, specialty drugs offer unique challenges:
  • Authorization workflow
  • Biologic samples require special handling including refrigeration
  • Copay cards are needed due to high out of pocket expense
  • Fluctuating value of the copay cards to accommodate different payer tiers
  • Expense of the biologic samples (where a handful of biologic samples equals the value of an entire traditional sample closet)
  • Patient access to all of the patient services
  • Coordination of the specialty pharmacy with the payer, doctor and patient
  • Lack of tracking or data available once the rep gives the doctor a refrigerated sample
  • The psychological impact that a patient may have a chronic condition and will be on biologic therapy for life
It’s easy to understand how a prescriber could set up patients for failure if patients are left to navigate the adjudication process themselves. Unless all of the programs are utilized, patients are doomed to be non-adherent.

As we know, patient support programs are available to help these patients, but the current supply chain and distribution system to provide access to the patient is broken.

So let’s rebuild it.

To successfully manage the specialty drug ecosystem, the interdependent stakeholders need an option to work together seamlessly and stop using fax machines from the 1980s. They need a vendor-neutral cloud-based hub to connect all 9 P’s of a specialty patient drug workflow:
  • Patient
  • Pharmaceutical/biotech company
  • Pharmacy (Specialty)
  • Provider/physician
  • Prescription
  • Payer
  • Phlebotomist/labs
  • Prior authorization services
  • Patient services
What would this look like? First, let’s start by providing a commercially independent and neutral hub (virtual marketplace) that the pharma/biotech company can upload all patient services, as illustrated in the following chart:

[Click to Enlarge]

The virtual marketplace eliminates the concerns of violating the anti-kickback and Safe Harbor requirements that are inherent in any program that includes direct manufacturer electronic distribution to the prescriber to the patient.

Next, lets make all of the patient services available to every stakeholder involved by implementing a cloud-based hub that integrates with every touch-point in the specialty drug process, including apps that:
  • Transfer the electronic samples and copay card credits to the doctor
  • Enable doctors to electronically order the patient services
  • Provide specialty pharmacies access to the patient services in the hub
  • Coordinate prior authorization, adjudication, and all patients services between the doctor and the specialty pharmacy
  • Create HIPAA compliant data management and reporting
  • Generate real-time data analytics dashboards for the pharma/biotech company
  • Manage physical inventory of specialty samples

[Click to Enlarge]

Utilizing this virtual marketplace and hub creates efficiencies for established distributors and 3rd party patient services because for the first time, the services can be electronically ordered at the most critical time – when the prescriber is still in the room with the patient.

My company, mRx Ventures, has built a solution to this problem utilizing our hub software, SamplifyRx. We are an early-stage venture that built the hub that our specialty industry so desperately needs, using feedback from the national thought leaders. I will be at the Armada Summit and look forward to any feedback to improve our solution. I can be reached at scott@samplifyrx.com or on my Armada Summit profile page.

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