Specialty pharmaceutical patients ‘have difficulty’ obtaining their first dose

The 2020 Medication Access Report, guided by a board of directors and disseminated by CoverMyMeds, the McKesson subsidiary that manages electronic prior authorization (ePA) processes (among other functions), finds ongoing obstacles in patients obtaining prescriptions, especially for specialty pharmaceuticals. According to survey data, 60% of specialty patients had “some difficulty” in receiving their first dose, and nearly one in 10 surveyed patients reported waiting eight weeks or more to receive that first dose.

These difficulties are well known; for years, industry has sponsored patient support services via internal or external hubs to address PAs and related issues. Many hub providers have “fast fill” programs to get a needed drug to patients even while the PA or reimbursement details are being worked out. CoverMyMeds itself now works with its sister organization, RxCrossroads by McKesson, on a program called Access for More Patients (AMP), to manage PAs, benefit verifications and related services. Despite these efforts, however, the access obstacle seems to be stubbornly constant.

Prescription abandonment

The relatively high cost of specialty drugs is clearly part of the access problem; insurers want to document the need for the drugs in fine detail; in addition, many plans put high copay or coinsurance hurdles in front of the patient. Here, data from another recent CoverMyMeds survey sees a worrisome trend: as out-of-pocket (OOP) costs increase, prescription abandonment rises. This, too, has been known for quite a while; the CoverMyMeds data indicate that a direct relationship can be calculated: for every $1 in added OOP, abandonment rises by 0.6%, reaching a level of 69% as costs exceed $250.

credit: CoverMyMeds

An executive summary of the 2020 Report is available at CoverMyMeds website; the detailed sections, however, appear only online and in pieces.