You know specialty medications’ critical role in treating complex or chronic conditions, but dispensing these prescriptions comes with unique challenges. Prescribers increasingly use specialty medications to treat their patients, but anywhere from 20% to 50% of those new prescriptions never get dispensed, leading to poor clinical outcomes and loss of pharmacy revenue. The healthcare industry needs to understand the factors that lead to unfilled specialty prescriptions–enabling them to take proactive steps to increase prescription fill rates.
In this post, we’ll discuss the root causes and provide practical solutions that you can implement into your practice to improve patient engagement and medication adherence and solve the “never-start” issue.
Understanding the “Never-Start” Problem
The never-start problem is when prescriber-generated specialty prescriptions never get dispensed by a specialty pharmacy and fail to reach the patient’s hands.
The problem has plagued the healthcare industry for years. With an estimated 20-50% of specialty prescriptions never being filled, this leads to a financial strain on the global health system and lost opportunities for patients to get their necessary treatments.
Traditional telephone-based approaches to engaging patients and providers regarding specialty prescriptions have proven inefficient in today’s age of digital technology, such as mobile or e-mails.
Patients are often subject to robo-initiated, telephone-based outreaches with a marketing intent, and as a result, a high percentage of the message goes into a spam file or is ignored. A shift in approach is needed to address the problem effectively, and providers and pharmacists must look beyond standard strategies, such as human-initiated phone calls, to reach their patients.
Identifying the Causes of the Never-Start Problem
Navigating specialty prescriptions from provider to pharmacy to the patient is challenging and costly for the entire healthcare industry. Increasingly, prescriber-generated specialty prescriptions are abandoned due to a lack of coordinated communication, the complexity of the prescription workflow process, such as prior authorizations, high out-of-patient pocket costs, or simply the inability of the pharmacy to reach the patient or provider.
A key reason for such high rates of specialty prescription “never starts” is because of a communication breakdown between the pharmacy and the patient.
Nine out of ten people indicate a strong preference for health care providers (i.e., physicians or pharmacists) outreach, yet the evidence strongly suggests that patient response rates are primarily ignored or delayed.
Quite simply, the identity of the health care provider is often unknown and difficult to separate from a marketing or sales outreach. Seventy-six percent (76%) of people say they’ve ignored or declined a call from a healthcare provider because they didn’t recognize their number.
Another one of the major causes of the never-start problem is affordability, as specialty medications often have high out-of-pocket patient costs. Patients often have to make a difficult choice between initiating needed therapies or delaying or even forgoing them due to cost.
The complexity of specialty medications and care regimens can also be a barrier for patients, underscoring the importance of patient education for potential drug interactions, medication adherence, and identifying and treating possible adverse events.
If a patient is not well-informed about their conditions and specialty medications’ role in managing them, it can often lead to confusion, skepticism, and a lack of motivation to start their treatment.
The Impact of Unfilled Specialty Prescriptions
The consequences of not filling a prescription are significant. For patients, not filling or delaying filling a prescription for a specialty medication can cause future complications in their health. Patients may experience an exacerbation of their condition, leading to hospitalizations, emergency department visits, and increased healthcare costs. This is even more severe for older adults requiring medication for multiple chronic conditions. Additionally, reduced patient engagement can lead to poor medication adherence, further compounding the problem.
On the other hand, the never-start problem also creates consequences for specialty pharmacy services. When patients don’t fill their prescriptions, it reduces revenue for the pharmacy. When a pharmacist cannot properly engage with patients and offer education about their condition and treatment options, it can lead to a poor patient-pharmacy relationship, negatively impacting the pharmacy’s reputation and the patients’ trust.
To overcome the problem of unfilled prescriptions, healthcare organizations are exploring more innovative approaches to reach and engage patients.
Strategies for Improving Medication Adherence and Pharmacy Patient Engagement
By leveraging patient engagement technology and other complementary creative strategies, these tools can better equip pharmacists to reach patients and remove barriers so they fill and refill their specialty prescriptions on time. These strategies may include text reminders, e-mail communications, automated refill reminders, and other outreach tactics.
The pharmacy can identify a financial barrier at the start of the process and help patients apply for financial assistance before the medication is dispensed. When a provider submits a script to a pharmacy, a patient engagement tool can automatically alert the patient to their out-of-pocket costs and assist in navigating the insurance coverage and prior authorization process. By digitizing the process, patients will be more likely to fill their prescriptions and begin treatment immediately.
Then, throughout the medication journey, engagement tools can send automated messages reminding patients to fill their prescriptions when refills are needed and providing them with up-to-date information about the side effects of their drugs. Pharmacists can also work with physicians to ensure that patients understand the benefits of their drug and how to take it properly. Alerts can help patients stay on track and improve understanding and confidence. Educating patients about their conditions, treatment options, and the medication’s importance will motivate them to continue treatment.
Additionally, patient data analytics to track engagement and medication use can help identify patients who may be at risk and need additional assistance filling their prescriptions, allowing pharmacists to intervene and provide support before the problem becomes severe.
Such systems are considerably more effective than traditional methods, such as phone calls, because these digital messages are more likely to prompt action.
Utilizing patient engagement tools and strategies can significantly reduce the number of unfilled specialty prescriptions and provide better patient care.
Considerations for the Never-Start Problem
Addressing the never-start problem requires a comprehensive approach. The root causes of unfilled prescriptions are complex and can vary depending on the patient’s individual circumstances. To effectively solve this problem, pharmacists and healthcare providers must work together to understand the underlying causes and take action to help patients.
Specialty pharmacies can use patient engagement technology like D2’s UltraTouch Engage software to improve the issue of unfilled prescriptions by providing automated, personalized communication, tracking patient progress, identifying patients at risk of not filling their medications, and increasing patients’ engagement with their healthcare journey.
By implementing these strategies, the healthcare industry can work together to improve medication adherence and patient health outcomes. If you want to speed up the fulfillment process, contact us to learn how.