The use of specialty medications is on the rise especially for the growing number of patients who are chronically ill with such complex diseases as cancer, multiple sclerosis and rheumatoid arthritis. However, these drugs are expensive and complicated to prescribe and dispense. Now that electronic prescribing (ePrescribing) is the norm for most other medications, it increasingly is being viewed as a solution to reduce the costs and administrative burdens associated with specialty prescribing.
Increased spending and utilization are major reasons why stakeholders are looking to ePrescribing as a mechanism to help contain the costs of specialty medications. Growth in spending for specialty drugs is far outpacing that for traditional drugs, and many new ones are in the pipeline. According to a 2013 analysis by Express Scripts, domestic spending on specialty prescription drugs is projected to increase 67% by the end of 2015. By then, cancer, multiple sclerosis and such inflammatory conditions as rheumatoid arthritis all specialty conditions will account for higher drug spending than any other therapeutic class except diabetes. A separate analysis by Prime Therapeutics predicts that, based on recent average yearly increases, specialty drug costs will rise 15% annually while non-specialty drug costs will remain flat. At this rate, specialty medications are expected to account for 50% of overall drug costs by 2018 for commercially insured individuals.
These huge outlays are directly related to the micro-level costs and use of specialty medications, which payers and pharmacy benefit managers (PBMs) are struggling to manage. Specialty medications often cost more than $2,000 per month per patient. Many cost much more, with the most expensive specialty drugs running upward of $100,000 to as much as $750,000 annually. This represents an obvious economic challenge for payers, while copays can be budget busters for many patients.
Specialty prescribing stakeholders also are looking to improve work flow and savings on administrative overhead through ePrescribing. Specialty prescribing has been mired in paper and yesterdays phone-fax processes, and should be brought into the digital age. ePrescribing can help facilitate the prior authorizations (PAs) that are needed for many specialty medications, reducing extensive outlays by pharmaceutical companies for administrative assistance for prescribers and patients and getting PAs approved much more quickly. The result: improved sales and less abandoned prescriptions. ePrescribing also can assist with risk evaluation mitigation strategies. For example, ePrescribing could streamline the coordination and communication of the authorization identification, which is necessary for medication ordering and patient reporting.
While ePrescribing holds much promise for addressing costs and workflow issues associated with prescriptions for specialty medications, they are outside todays ePrescribing process. Stakeholders have been working on solutions and progress has been made. As nationally known experts in health information technology (health IT) and ePrescribing, Point-of-Care Partners (POCP) has four ideas on how to gain additional traction for ePrescribing of specialty medications.
POCP is working closely with stakeholders to move ePrescribing of specialty medications forward and monitor progress. Let us know if we can give you an in-depth picture of the opportunities and challenges.