Shots:
- Specialty medication access remains challenged by high costs, fragmented workflows, complex prior authorization requirements, and limited transparency, leading to delays, prescription drop-offs, and suboptimal patient outcomes.
- DrFirst is addressing these gaps through AI-powered, workflow-integrated solutions that enable real-time benefits verification, targeted prior authorization automation, and smarter pharmacy routing, shifting care from reactive problem-solving to proactive, frictionless prescribing.
- PharmaShots welcomes Colin Banas, CMO at DrFirst, for an insightful and forward-looking conversation
Saurabh: Specialty medications continue to grow in complexity and cost. What are the key challenges today that delay patient access and impact outcomes?
Colin: The problems come from multiple directions. For patients, cost is often the first wall they run into. Out-of-pocket expenses can reach thousands of dollars, and financial assistance programs exist but are hard to navigate. When you add in other considerations like limited distribution networks and separate pharmacy and medical benefit prior authorization (PA) requirements, patients often have no visibility into where they are in the process.
On the provider side, I can tell you that physicians are being asked to play a game they don’t know the rules to. A typical office visit runs 15 to 20 minutes. In that window, I’m addressing the patient’s concerns, reviewing their history, and documenting in the digital record. I’m not an expert in payer criteria, PA requirements, limited distribution logistics, and financial assistance options for every drug I might prescribe. And with roughly 75% of the approximately 7,000 drugs currently in development qualifying as specialty medications, that’s an increasingly unrealistic expectation.
After all this, even when a patient leaves the office motivated to start therapy, their prescription may not be filled, and days or weeks can pass with no update on PA status, no connection to copay resources, and no guidance on next steps. Then, the momentum is gone. What makes this so urgent is that for many of these therapies, days can be clinically consequential. Getting the prescription right upstream is critical so it doesn’t cause delays and rework downstream.
Saurabh: Timely by DrFirst recently introduced a new initiative to transform the specialty medication space. Could you share the vision behind this announcement and the gap it aims to address?
Colin: Existing e-prescribing workflows weren’t built for specialty medications. So it’s not surprising that clinicians get stuck in a cycle of rework: the prescription is sent, the pharmacy calls back to resolve an issue, the doctor’s staff scrambles, and the patient waits. This is a big reason why more than half of new specialty prescriptions never reach the patient.
We can resolve these issues upstream before they delay care. Within the e-prescribing workflow, after the provider selects a medication, Timely delivers real-time intelligence based on the patient and the drug, such as benefits verification, pharmacy routing, and prior authorization criteria. We are seeing extremely strong results in a series of pilots. For PA, we can typically ask just a few targeted questions that clinicians answer and move on, resulting in a 60% PA completion rate. Similarly, for drugs that commonly trigger pharmacy follow-up, our ability to ask targeted questions has resulted in 56% fewer change requests.
It is always better to catch these problems at the point of prescribing.
Saurabh: Administrative burden remains a major concern for providers. How does your platform integrate into clinical workflows while reducing friction for physicians?
Colin: I’ve been in the informatics field for more than 20 years, and I’ve seen alert fatigue get worse every year. The old model drops a wall of text in front of a provider and stops them cold before they can move on. At DrFirst, the goal is to surface the right information at the right moment without adding friction to the prescribing workflow. Clinicians tune out alerts they can’t act on quickly. That’s the problem we are solving.
We do that with clinical decision support that’s actionable and embedded directly in the workflow. Think of it like GPS systems: After you select your destination, they guide you, so you can choose your path and arrive as quickly as possible without unexpected delays and detours. But you decide the route you want to take. In the same way, after the prescriber selects the medication, the system should make the chosen path as efficient as possible.
Saurabh: AI and automation are becoming central to healthcare innovation. How is DrFirst leveraging these technologies within this new solution to streamline specialty prescribing?
Colin: AI is not greater than the doctor. But AI plus the doctor is greater than the doctor alone. AI is not new to the informatics world. It’s been applied operationally for close to a decade. What’s different now is the flavor of AI and what it’s capable of.
One of the most meaningful applications is our AI-enabled question set automation, which simplifies prior authorization requests. We’ve analyzed millions of PA submissions and understand that for the vast majority of them, there are one to three targeted questions specific to the selected drug and the patient that, if answered at the moment of prescribing, dramatically increase the likelihood of PA completion. When clinicians select a medication, our AI and machine learning allow us to surface those questions in real time. That’s how our pilots have achieved a 60% PA completion rate across a broad range of therapies, not just a handful of specific payer and drug combinations.
Saurabh: Prior authorization is often cited as a major barrier. How does your approach simplify or accelerate this process for specialty medications?
Colin: I think about prior authorization through what I call the three A’s: avoid, accelerate, and automate.
The best PA is the one I never have to do. If I follow all the rules upstream—correct quantity limits, the right number of refills, the appropriate diagnosis code—I may be able to get the PA approved quickly. Many PAs aren’t flagged because the therapy won’t be covered under any circumstances. They’re flagged because the prescription was written in a way that doesn’t meet the payer’s guidelines. Fix that upstream, and you eliminate a whole category of delays.
If I can’t avoid it altogether, I want to at least accelerate it. Maybe that’s just two or three targeted questions about the indication, prior therapy history, or refill limits. Suddenly, I’m 90% of the way through the process before it even formally begins.
Saurabh: Patient visibility into cost and access is often limited. How does your solution enhance transparency and engagement throughout the treatment journey?
Colin: There’s a painful scenario that plays out too often: A provider writes the prescription, and the patient gets to the pharmacy counter only to discover the cost is completely unmanageable, which the physician had no visibility into at the time of prescribing.
On the patient side, the Timely engagement platform connects patients to cost-saving opportunities, educational materials, and next steps so they aren’t left trying to figure it out on their own.
But equally important is what happens on the provider side. If a physician has real benefits and price transparency at the point of prescribing, he or she can make better decisions and have conversations with their patients before there’s a problem at the pharmacy. The further upstream we bring that visibility, the better the outcome for everyone. When the prescription is written so it’s ready to fill, and the patient is informed and prepared, we can stop chasing problems after the fact.
Saurabh: Specialty drugs often involve complex distribution networks. How does DrFirst ensure accurate routing and coordination between prescribers, pharmacies, and payers?
Colin: Our approach is to solve this at the source. After a provider selects the appropriate medication, Timely lets them know if it can only be filled by a specialty or limited distribution pharmacy. So before the patient leaves the office, the doctor and patient can choose a pharmacy that’s able to fill the prescription.
Saurabh: Looking ahead, how do you see digital health solutions shaping the future of specialty medication access over the next few years?
Colin: The thing I’m most excited about is the shift from measuring how well we fix problems to preventing them from happening in the first place. Other solutions may get a PA down from seven days to two days. That’s progress, but it’s still measuring corrective actions. The more interesting question is: What if we avoided the PA entirely? What if the prescription was written from the start so none of that back-and-forth—what we call prescription ping-pong—had to happen?
That’s the direction things are heading, and what makes it possible now is the combination of scale, data infrastructure, and AI working together in a way that simply wasn’t feasible before. DrFirst has hundreds of thousands of providers using our solutions, and that volume lets us identify friction points, run experiments, iterate, and improve, sometimes within days rather than months. For example, when we first launched the program that ultimately cut pharmacy change requests in half, only about 20% of providers clicked on the alerts. In less than two weeks, that number rose to 75% as we optimized the messages based on user actions.
We are reshaping the prescribing workflow to anticipate problems specific to the patient, the drug, and the payer before the clinician even finishes writing the order.
About Colin Banas
Colin Banas, MD, MHA, serves as Chief Medical Officer at DrFirst, where he leads innovation in medication workflows and clinical decision support. He joined the company in 2019 after 17 years at VCU Health System as Chief Medical Information Officer and practicing internal medicine hospitalist. A recognized health IT leader, he has testified before the U.S. Senate and advised the ONC. Banas focuses on leveraging AI to reduce clinician burnout and improve patient outcomes, and was named the 2017 HIMSS-AMDIS Physician Executive of the Year.
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