Shots:
- Fragmented workflows continue to be a major roadblock in the healthcare ecosystem, causing unnecessary delays in care delivery
- Automated solutions help bridge the gaps resulting from disjointed workflows and expedite prior authorization, pharmacy routing, and patient onboarding
- Colin Banas, CMO at DrFirst, joins PharmaShots in a discussion highlighting the company’s recent acquisition of Myndshft Technologies, real-time price transparency technology, and describes a wonderful concept, “Unite the Healthiverse”
Saurabh: What are the most significant barriers to specialty medication access that DrFirst is addressing through its innovative solutions, such as electronic prior authorizations?
Colin: The roadblocks to getting patients on specialty medications are frustratingly familiar for everyone in the process. The common denominator is disconnected workflows between prescribers, pharmacies, and payers. It leads to prior authorization delays, patients wondering what’s happening, how they are going to afford the medication, or giving up because the process is so opaque.
Opaque is the right word. Prescribing specialty medications can feel like a black hole for nearly everyone involved.
The doctor who writes the prescription often doesn’t know if a prior authorization (PA) is required, what information the payer needs, or the status of the request. The pharmacy is often stuck in the middle, having to ask the doctor for more information to complete the PA, resulting in a time-consuming game of ping-pong between pharmacists and doctors. (That’s something that really drives both doctors and pharmacists crazy!) And through it all, the patient is left wondering what’’s going on. So much of this friction can be solved by giving the entire care team and the patient access to the right data at the right time.
DrFirst is focusing on making everything about this work better. This includes electronic prior authorizations, but also goes far beyond it, such as automating how information is shared between doctors, pharmacies, payers, and patients.
We are shining a light where it’s dark so doctors can see each patient’s prescription benefits and prior authorization requirements while they are in workflow. This transparency extends to pharmacies so they can add information to the PA if needed, such as previous medications that would satisfy the required step therapy. Transparency also helps patients with text updates on the PA status, what their out-of-pocket costs will be, and financial resources to help them afford high-cost specialty medications.
Throughout it all—from the time the doctor is writing the prescription to the time it gets to the patient—our goal is for the prescription to get to the pharmacy ready to fill. There are so many variables that can be blockers here. Pharmacies have different requirements for how the prescription needs to be written based on their systems. Insurance companies have different requirements for complex specialty medication PAs, as well as the quantity of medication they will cover per month.
Until doctors, patients, and other stakeholders can see inside this black hole, patients won’t get the improved access they need to specialty medications.
Saurabh: How does DrFirst’s acquisition of Myndshft Technologies enhance the integration of medical and pharmacy benefits, and what impact has this had on improving patient access to specialty medications?
Colin: The fact that the specialty medications are split into two administrative silos comes as a big shock to most people. You have the pharmacy benefit on one side and the medical benefit on the other, and they operate with completely different rules for prior authorizations. That’s why practices that prescribe a relatively higher volume of specialty medications, like oncologists, have several staff positions devoted to walking (and faxing) prior auth requests to completion, often with several go-rounds.
Infusions are just one example of drugs that are covered under the medical benefit, not the pharmacy one. Doctors are already frustrated with an opaque PA process for prescribing. Complicating it with a fork in the road, when we really want a simple, straightforward path, only adds to the frustration and delays—the last thing patients need when their health is on the line.
The Myndshft acquisition allows us to provide a full picture of the patient’s benefits. Prescribers can see medical and pharmacy benefits in one clear view, helping eliminate nearly a third of unnecessary prior authorizations. This takes the old saying “time is money” to a new level: “time is lives.” That’s why it’s vital that patients get their medications as quickly as possible. When you can speed up the process of prior authorization or avoid it entirely by having the right information in the prescription, everyone wins.
Saurabh: Can you elaborate on how DrFirst’s real-time price transparency technology helps providers identify lower-cost alternatives and cost-saving resources to reduce prescription abandonment rates?
Colin: Every retail pharmacist I know has had patients get to the pharmacy counter and walk away without their medications when they discover they can’t afford them. And almost every doctor I know has discovered, often too late, that patients may have filled their prescriptions but are taking sub-therapeutic doses to make them last longer.
Providing doctors and patients with real-time prescription benefit information makes a critical difference. DrFirst originated this technology, which connects directly with payers and PBMs to show a patient’s actual out-of-pocket cost in real time. If patients meet their deductible that morning, the price we show that afternoon reflects it and flags available copay and discount cards.
This means doctors can discuss options with patients before the prescription is sent to the pharmacy. And if doctors decide to prescribe a more affordable option, they can make that change without having to restart the entire order.
Patients also get this visibility into out-of-pocket costs. Shortly after the doctor writes the prescription, patients get an SMS message informing them where it was sent and what their out-of-pocket costs are, with links to available cost-saving financial resources. These messages increase first-fill rates by up to 10% or more.
Saurabh: What role does DrFirst’s Healthiverse concept play in streamlining workflows and improving collaboration among prescribers, pharmacies, and payers for specialty medications?
Colin: It’s no secret that the healthcare system is extremely complex and fragmented, especially when it comes to information sharing and clinical collaboration. DrFirst coined the term “Unite the Healthiverse” to represent our vision for connecting healthcare stakeholders with the information they need when they need it. Simplifying workflows and improving collaboration is the core of how we do it.
Specialty medications are a perfect example of why Uniting the Healthiverse is urgently needed. They typically involve a web of special considerations that vary by drug and insurance coverage—such as which pharmacies can dispense them, how the prescriptions need to be written, prior authorization specifications, and more.
Right now, so much time is lost while doctors, pharmacists, and payers reach out to each other with faxes, calls, and emails. As a doctor, I can tell you from personal experience, it’s incredibly frustrating. But more importantly, it causes unnecessary delays for patients who need these medications.
DrFirst is connecting healthcare stakeholders for real-time collaboration, automating processes to meet specific needs, and bringing transparency to prescription benefits and prior authorization requirements. Patients are the winners when uniting the Healthiverse means they have better outcomes.
Saurabh: How does DrFirst ensure that prescriptions are routed to the correct specialty pharmacy while addressing the challenges of limited distribution networks and complex handling requirements?
Colin: One of the most frustrating parts of prescribing a specialty medication is the guesswork involved in getting it to the right place.
Many high-cost specialty drugs have complex handling requirements and may only be available through a specialty pharmacy or a limited distribution network. The problem is that this information has not been part of the prescribing workflow. As a result, prescriptions often get sent to the patient’s regular preferred pharmacy, which can’t fill the prescription, making the whole process take much longer—if the prescription even gets filled at all. Patients have enough to worry about with the stress and confusion this creates, not to mention the potential for their health to worsen.
We focus on making it easy for doctors to know if the medication needs to go to a different pharmacy while they are writing the prescription and to select where to send it. Before the prescription is sent, our system lets the provider know in workflow if it needs to be routed to a specialty pharmacy or is part of a limited distribution network.
This eliminates guesswork and rework that can cause needless delays. It’s a simple but powerful idea: make sure the prescription arrives at the pharmacy ready to fill so the patient can start their therapy as soon as possible.
Saurabh: How else is DrFirst expediting access to high-cost specialty therapies?
Colin: One breakthrough we discovered was the power of nudging providers to enter ICD-10 diagnosis codes early in the prescribing process when it can expedite prior authorizations. Because we can do this within workflow, we achieved a tremendous improvement in the number of prescriptions that included diagnosis codes, going from 11% to nearly 70% in the first several weeks of the program.
This is significant because, in many cases, the diagnosis code is all that’s needed to meet the PA requirement. By encouraging providers to include diagnosis codes from the start, we’re giving payers what they need to say “yes” faster. These early wins show us that you can see a big impact when you provide more complete, actionable information in workflow.
Saurabh: Looking ahead, how do you envision AI and digital innovation shaping the future of specialty medication access, particularly in terms of affordability and patient support services?
Colin: People have come to expect real-time updates and transparency from every other part of their lives, except for healthcare. For example, you can order a pizza and know when it’s being assembled, cooked, and on its way to you. And if you place an Amazon order, you can make some changes until it ships. But doctors, pharmacies, and payers are still faxing each other.
The healthcare industry has some serious catching up to do. DrFirst is on the leading edge of innovations to do just that.
Across the medication journey, our AI and workflow expertise makes it possible for EHRs, providers, pharmacies, and payers to share clinical information and collaborate across systems.
These innovations in AI and automation are designed for clinicians by clinicians and make it possible for:
- Doctors to see certain information so the prescriptions they send to the pharmacy are ready to fill upon receipt, such as knowing if the drug is part of a limited distribution network, or the insurance company requires a diagnosis code.
- Doctors, pharmacies, and payers to collaborate in new ways, with flexible workflows that automate inefficient processes and share vital clinical context in real time, which is especially critical for access to specialty medications.
- Patients, as well as their doctors and pharmacies, to see exactly where their prescription is in the process, the status of prior authorizations, and what steps they need to take.
Looking ahead, we believe these innovations will bring a much-needed “modern-day” experience for patients (and doctors, pharmacies, and payers, too).
About the Author:
Colin Banas, M.D., M.H.A.
Chief Medical Officer
Colin is an Internal Medicine Hospitalist and former chief medical information officer for VCU Health System in Richmond, Virginia. He has testified before the U.S. Senate and the Office of the National Coordinator (ONC) on health IT and the Meaningful Use program and is a former Health IT Fellow for the ONC. His interests center on the role of big data and analytics on patient outcomes and on novel forms of clinical decision support that are outside the realm of traditional rules and alerts, including real-time dashboarding and intuitive usability designs.
Related Post: CXO Talks: Colin Banas from DrFirst in an Illuminating Conversation with PharmaShots
