Tom examines how intake speed and time to therapy relate to each other in specialty pharmacy programs. He describes how bringing pharmacy connectivity to the front of the patient journey can support faster benefit verification, clearer affordability answers, and shorter time to therapy.
To learn more about CareMetx's pharmacy model, download their guide, The Hidden Cost of the Hub-to-Pharmacy Handoff (and How to Close the Gap).
Read on for Tom's insights.
Fixing the Front Door Isn’t the Same as Fixing Time to Therapy
Tom Traylor, Senior Vice President, Pharmacy Operations, CareMetx
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The biggest obstacle has consistently been missing information, which is why so much recent investment has gone into digital intake. The idea is simple: cut the time it takes for information to reach the hub.
A number of tools have made real progress on that front. Prescriptions now reach the hub in seconds instead of days, and providers have faster ways to submit them. We built these tools to fix the delay at intake, but what we learned along the way is that speed of arrival isn’t the same as completeness. Arriving fast doesn't help if what arrives can't be acted on.
A prescription can arrive at the hub in seconds and still be missing a clinical detail, carry inaccurate coverage information, or need more documentation before a prior authorization can move forward. Data presented at this year's Access USA conference put the cost of resolving those gaps at three to seven days of added processing time.
The bottleneck, in other words, isn't how fast information arrives; it's whether it's usable once it gets there. Fortunately, that's a problem specialty pharmacies already solve every day, and necessity has made them good at it. Before dispensing, a pharmacy has to identify anything missing, chase it down with the provider, verify benefits, and move prior authorization forward. The discipline already exists—it's just confined to the last step of the journey.
In my view, the opportunity for manufacturers is to bring that discipline forward.
The Pharmacy as the Front Door, Not the Last Stop
In the traditional model, the hub and the pharmacy are two separate stops, and the pharmacy is the second one. A patient enrolls, the hub verifies benefits, submits and tracks prior authorization, and screens for affordability. Only once all of that is resolved does the prescription move to a specialty pharmacy to be filled. The irony is that some of the slowest parts of that upstream work—chasing down a missing lab result, verifying benefits accurately, moving a prior authorization forward—are things a connected pharmacy is already built to do quickly.
At CareMetx, our approach starts with one shift: bring the pharmacy in at the beginning of the process, not the end.
In practice, that means the pharmacy's connection to the provider's EHR becomes available right at intake. If a lab result or a phone number is missing, the pharmacy can pull it electronically instead of the hub having to contact the provider's office and wait for a response. The same is true for prior authorization. Rather than waiting for enrollment and benefit verification to finish before a PA process even starts, a pharmacy can identify the payer, generate the authorization key, and begin tracking status immediately—and if a denial comes back, it can trigger the start of the appeal process right away.
What Changes in Practice
When a licensed, connected pharmacy sits at the front of the journey, three things change together:
- Intake stops waiting on a callback. If a clinical detail is missing, the pharmacy pulls it electronically from the provider's EHR rather than phoning the office and waiting for a response.
- Access clearance produces a real number, not an estimate. In many hub models, benefit verification produces a rough approximation of what a patient will likely owe, based on limited information about their plan. It's useful as a starting point, but it isn't a confirmed number, and it can turn out to be wrong once the actual claim is processed. A connected pharmacy can verify benefits with far greater precision, which means the number a patient sees earlier in the process is closer to what they'll actually pay. The same logic applies to prior authorization: instead of waiting for enrollment to close before that process even begins, it can start immediately, with the pharmacy identifying the payer and tracking the outcome in real time.
- Affordability gets resolved without a separate step. Free-goods programs and bridge supply are typically administered under the manufacturer's program rules through the same pharmacy that will eventually dispense the therapy. Once that pharmacy is involved from the start, there's no need for a second, disconnected process to determine whether a patient qualifies for assistance. In the most connected version of this model, that determination can begin as soon as the prescription is received, sometimes before enrollment paperwork has even been completed. By the time a patient might otherwise be asking about cost, the answer is often already available.
This is the model we've built at CareMetx, designed around a simple premise: pharmacy speed doesn't have to wait until the end of the journey to matter.
We've put together a closer look at what it takes to build a program this way—plus the questions worth asking your current or prospective hub partner to find out whether pharmacy speed is working for your patients today, or still sitting at the end of the line.
Download the guide—The Hidden Cost of the Hub-to-Pharmacy Handoff (and How to Close the Gap).
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