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By Kendra Obrist, Senior Consultant
The increasing use of oral specialty products is an under-the-radar trend that might help spur the rise of electronic prescribing (ePrescribing) of specialty medications. To be sure, ePrescribing of specialty medications is used today but on a limited basis (as compared with ePrescribing of nonspecialty medications). However, stakeholders are looking to increase use of ePrescribing to reduce costs associated with these expensive therapies, improve patient outcomes and lessen the overhead and inefficiencies created by specialty prescribing’s antiquated phone-fax-paper processes.
In the recent past, most specialty drugs were injected or infused in a physician’s office or other health care setting, covered under the patient’s medical benefit and ordered by treating physicians rather than prescribed. However, this is beginning to shift in favor of orals. According to one analysis, more than half of specialty drugs now in the pipeline are high-cost oral medications, which are increasingly being developed to substitute such other treatment as injectable drugs provided in physician offices, outpatient settings or infusion centers. Oncology is one of the nation’s predominant therapeutic areas; about a third of today’s anti-cancer drugs are oral, and that percentage is expected to grow in the near future.
Several reasons account for the increased use of oral specialty drugs. The convenience of oral, targeted therapies is attractive to many physicians and patients. Many physicians believe that oral therapies make it easier for patients to manage their own care, thus increasing adherence, improving outcomes and reducing costs. Oral medications are also easier to ship and store, making them more amenable to store-based distribution and improving supply chain control by manufacturers.
Increased use of oral specialty medications should help drive ePrescribing in two ways. First, ePrescriptions for oral medications are more easily accommodated in the current ePrescribing work flow than those for specialty drugs with other forms of administration. Second, when patients take specialty medications orally, the pharmacy benefit associated with their health plan generally provides coverage, which also closely fits with current ePrescribing processes. This also falls in line with the general trend of shifting coverage for specialty medications to the pharmacy benefit rather than the medical benefit.
All in all, the time is right for increased ePrescribing of specialty medications. Because ePrescribing now is a standard of care for nonspecialty medications, it is easy to consider it for specialty prescriptions. According to Surescripts, nearly three-quarters (73%) of office-based physicians were ePrescribing in 2013 and nearly all retail pharmacies were wired to receive ePrescriptions. An analysis by the Congressional Budget Office projects that 90% of physicians are expected to adopt health information technology, including the ability to electronically prescribe, by 2018. In addition, ePrescribing standards are already well established and there is a robust technology infrastructure that ensures a high level of standardization and interoperability.
Prior authorization, a requirement for nearly all specialty medications, can now be done electronically thanks to new electronic prior authorization transactions, which have been developed and are available for use as part of the NCPDP SCRIPT standard.
Despite the progress that continues to be made, modifications will be needed to current ePrescribing practices and ePrescribing systems to accommodate specialty prescribing.
For example, many key pieces of clinical and administrative information are not provided in ePrescriptions for specialty medications that could be communicated through the NCPDP SCRIPT standard. Systematically adding the diagnosis to prescriptions would eliminate the need for manual entry and reduce many opportunities for error, as well as expedite processing of prior authorization (PA) requests. While diagnosis is currently an available field in the NCPDP SCRIPT standard it is not required. Other needed data that could be communicated via NCPDP SCRIPT include the patient’s clinical data, such as laboratory values, height, weight, allergies and other indicators; contact information; insurance policy number, which is needed to determine eligibility and coverage/copay information; and the status of a PA request (approved, denied or pending), which is necessary to facilitate billing and delivery of the specialty medication.
Modifications must be made to ePrescribing functionality in electronic health records (EHRs) to accommodate specialty medications. EHRs will need to allow physicians to select from more drugs than may currently be presented for consideration. Not finding the specialty pharmacy in the ePrescribing work flow may cause delays in treatment initiation, resulting in patient dissatisfaction and additional work for the physician.
Resolution of such issues will ensure that ePrescribing of specialty medications will increase, facilitated by ePrescribing of oral specialty medications in particular.