Friday, April 15, 2022

Kristy’s Story: Navigating Specialty Medication Challenges

Today’s guest post comes from Megan Marchal, Director of Specialty Pharmacy Strategy at CoverMyMeds.

Megan discusses the access and affordability challenges faced by specialty therapy patients. She describes how CoverMyMeds’ centralized technology solutions—paired with experts familiar with each therapy—help patients navigate these challenges. And, she shares one patient’s personal journey.

To learn more about CoverMyMeds’ technology solutions, visit Booth 229 at the Asembia Specialty Pharmacy Summit in Las Vegas, May 2-5, 2022.

Click here to sign up for CoverMyMeds’ Asembia Specialty Pharmacy Summit recaps.

Read on for Megan’s insights.

Kristy’s Story: Navigating Specialty Medication Challenges
By Megan Marchal, Director of Specialty Pharmacy Strategy, CoverMyMeds

The oft-used metaphor of a patient’s “path” to medication access sometimes oversimplifies how rocky the journey can be—especially when it comes to accessing specialty medications. More appropriate comparisons may be winding backroads or even mazes, fraught with dead ends and U-turns.

In a recent CoverMyMeds survey of 1,000 patients, 82% experienced a delay in receiving their medications. When we zoomed in on only patients prescribed specialty medications, this number increased to 87%.

While the numbers are sobering, they’re unsurprising when considering the characteristics of specialty medications—they’re expensive, complex and can have a limited distribution model. Each nuance comes with its own set of processes that can delay time to therapy.

Fortunately, innovative centralized technology solutions, coupled with experts familiar with the complexities of each therapy, can help smooth the path to specialty medications for both patients and their care teams. Such solutions have been shown to help patients get their medications eight days sooner when comparing electronic methods to manual. (CoverMyMeds data on file. Case study of programs analyzed from April 2019 to November 2021)

By recently integrating strengths to create one CoverMyMeds team, we further distinguished our ability to help simplify the path to specialty medications through every stage of a patient’s journey, from automated enrollment to support beyond first fill. Our newly enhanced patient support solutions provide guidance through prior authorizations, benefits investigation, financial assistance and patient education, all in one platform.

Through an electronically enhanced approach, CoverMyMeds’ integrated solutions also allow real-time visibility to the patient’s access status, and help keep key stakeholders informed—most importantly, patients like Kristy.


Kristy is living with myelofibrosis, a rare blood cancer. While there is no cure, she does have a treatment—but just one. While reliable therapy is reassuring, having a single point of failure for treatment compounds the stress of each hurdle she’s faced trying to access her specialty medication.

“I feel like I’ve been through the fire with this medication,” she said. “It’s been really scary not knowing if my medication was going to be covered.”

Kristy’s experience is an unfortunately common example of how challenging specialty medication access can be for patients. Perhaps most frustrating was when Kristy learned her only treatment option available wasn’t covered by her insurance. Solutions that provide transparency into benefit decision processes can help alleviate the stress of the unknown for patients and care teams.

Medication access delays are often related, but not limited to, to financial obstacles. Of patients who experienced any delay in receiving medication in the past 12 months, 85% had to make financial sacrifices related to medications, either forgoing bills or medications or modifying treatment to stretch out prescriptions. This is compared to patients who didn’t experience delays, with only 33% of these patients making the same sacrifices. Kristy sympathizes with other patients.

“I've shed many, many tears over trying to jump through hoops to get the medication and the debt that the medication’s caused,” Kristy said. “I can't imagine jumping through all those hoops and going through appeals and denials on top of feeling ill.”

Solutions inclusive of patient affordability options can help care teams connect patients to affordability safety nets. Specialty-specific hub solutions can further help care teams get ahead by surfacing patient-specific plan requirements in workflow—which would significantly help the 49% of providers who don’t feel they had the necessary benefits information to start patients on specialty medications.

Integrated patient support solutions can also afford care team members more time. In a recent survey, 69% of providers said they spend at least an hour per patient coordinating steps to start a complex therapy, and 18% spend at least three hours. With solutions enhanced with electronic capabilities, care teams experience 85% faster enrollment completion compared to traditional processes. (CoverMyMeds data on file. Case study of programs analyzed from April 2019 to November 2021) This time savings can allow care teams room for educational and shared decision conversations with patients so they know what to expect at the pharmacy. This is critically important for patients like Kristy, who have no medication alternative should they be denied access or find their medication is too expensive.

“I didn’t have a choice in leaving it at the pharmacy ... so you pull out the credit card and swipe,” Kristy said.

With over 50% of patients making medication-related sacrifices in the last year, understanding options—and keeping track of approval processes—can make a huge difference when it comes to adherence and patient outcomes

There are many patients like Kristy struggling to ensure they have access to the medications they need, which is why we’re committed to simplifying patient paths to specialty therapies. You can connect with us about solutions for accessing specialty therapies at Asembia's Specialty Pharmacy Summit May 2-5, 2022 in Las Vegas. Learn more about our plans and sign up for our conference recaps and our point of view on topics discussed.

Sponsored guest posts are bylined articles that are screened by Drug Channels to ensure a topical relevance to our exclusive audience. These posts do not necessarily reflect our opinions and should not be considered endorsements. To find out how you can publish a guest post on Drug Channels, please contact Paula Fein (

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