Authorization for Specialty Drugs Still a Patient Hurdle, Report Says

A series of reports from a subsidiary of drug distributor McKesson says patients are having trouble getting the medications they need—particularly specialty medications—due to prior authorization requirements and cost, among other things.

In its 2020 Medication Access Report, CoverMyMeds said electronic prior authorization (ePA) can help speed up the process to get approval for specialty medications. ePA can cut approval time from 17 days using phone and fax to as little as 1.5 days, the report said.

According to one survey conducted by the company, 60% of patients have reported some difficulty in getting their first dose of a specialty medication. A survey of providers said that 91% of them said that prior authorizations have delayed care, and 75% reported that the prior authorization process caused their patients to abandon treatment.

Providers are using outdated technology such as phone and fax to complete prior authorization requests, and this is part of the problem, the report said. On the approval side, nearly 100% of payers and pharmacies accept ePAs.

Other reasons have to do with physicians not acting soon enough. Only 17% of providers say they initiate the prior authorization request at the time the prescription is written, with the majority of the requests, 60%, happening retrospectively. Another 20% complete the request after a patient tells them authorization it is needed.

At the same time, a majority of providers report a heavy administrative burden completing the authorization request—an average of 2 business days a week. That burden has increased over the past 5 years, 88% of providers said.

The administrative process cuts into time with patients, said 26% of providers; and 16% said they have less time to interpret lab and scan results.

The use of costly specialty meds, often for rare and chronic conditions, is increasing at more than twice the rate of other medications. They account for 45.4% of total pharmacy spending, this week's report said; a different report from CVS Health predicts that specialty drugs will soon account for 55% of US drug spending, as more expensive, although potentially curative, therapies are in the pipeline.

To facilitate access to specialty medications, vendors, or so-called hubs, that provide patient support have sprung up, the report notes. Specialty pharmacies can also provide assistance. But only 40% of providers and 80% of patients are aware of the services, the report said.

Financial Hardships

The use of specialty medications has also created affordability issues for patients, the report notes. Some 29% said they have quit their therapies. With the rise of high-deductible health plans, which force patients to pay more out of pocket (OOP), patient abandonment of treatment has become more common. For each dollar increase in average OOP costs, the report said, prescription therapy abandonment rises 0.6%, the report said.

AARP noted last year that the average annual price for a single specialty drug used for a chronic condition for a Medicare beneficiary is $79,000. The CoverMyMeds report said 69% of patients surveyed have made “personal sacrifices” when the deductible is in effect.

Although the cost of specialty drugs is an increasing concern for patients as well as payers and employers, another recent report said that few US health plans select biosimilars as a cost-savings option. Just 14% of US health plans selected a biosimilar as the preferred drug in the time period covered by the report.