The last two years challenged and changed healthcare. As professional and personal routines broke, many reevaluated priorities, reimagined work-life environments and reconsidered choices that affect health, as mass vaccination and pandemic preventative measures became top priorities.
In turn, individuals and organizations widened the lens on health, and the healthcare ecosystem has begun to address this wider view, though not without inherent challenges.
For patients, financial, relational, social and environmental factors can impact available care options and account for up to 80% of health outcomes. Even under the best of circumstances, physical health can still require medication intervention. Obtaining and adhering to these medicines can prove trying, with no set of complications the same. The COVID-19 pandemic brought to light a harsh reality that’s long existed: When a person’s physical health is their most stable determinant, they’re living one illness away from crisis.
Recognizing this quandary, many health systems and their surrounding communities showed resiliency in the past two years by reengineering their operations to better serve patients holistically. The nascent systems born from the pandemic, built to address a broader set of patient needs, could mature to transform the healthcare industry and medication access beyond pandemic times.
As the country reopens and eases back into routines, it also walks back into a world of possibility, digitized and diversified through months of change. Regulations and technology flexed to help patients access healthcare and medications during lockdown measures, though many are returning to pre-pandemic norms. Care teams solutions can hold and surface mountains of data, but the data is only as good as the actions they can take with it. Action hinges on real-time availability, access equity and communication capabilities, all of which are works in progress within the broader healthcare ecosystem.
To realize a potential new paradigm, healthcare needs technology, not only to support future systems, but also to more immediately help care teams, stretched thin from staffing shortages and extraordinary demands. Advances in telehealth, digital communication and EHR and pharmacy system interoperability could help alleviate the burden on clinical care teams and pharmacists so they can better serve patients who rely on them. Rather than reverting to pre-pandemic systems, the healthcare industry has a golden opportunity to build on and cement recent changes to make them a part of the permanent ecosystem.
To promote better access to medications and care, turning the innovation compass from creations to connections will be the most impactful in the near and long term.
Steps toward accessible, equitable outcomes-based care include engaging patients in shared decision-making; improved data integrity and sharing among providers, payers, biopharma and pharmacists; and nimble automation across the entire healthcare ecosystem.
This year’s report details what’s needed to progress toward a healthier, smarter, more equitable medication access system.
** Read real stories of people who have faced medication access and healthcare challenges in the past year.**
While the COVID-19 pandemic has wrought unquestionable turmoil and tragedy, it’s also transformed healthcare.
For decades, healthcare has been at least one industrial revolution behind many industries. Healthcare’s nuances, various stakeholders and tight regulations make technology advances slow to adopt and often disjointed. The pandemic, global in both geography and scope, was a catalyst for innovation and connectivity in the healthcare industry.
Data shared through these innovations and connections could help address patient difficulties experienced in the last year. Where the first year of the pandemic brought about unease, shock and raw grit, the second year has not brought relief, but an evolved set of variables. For many, the pandemic-induced economic and social fallouts have become more fully realized. Patients and care teams face worsening illnesses, medication affordability challenges, unequal access to proper care and mental distress.
Distancing, delays and undiagnosed conditions
In the last 12 months, 84% of patients have had to delay or forgo in-person healthcare visits, mostly due to COVID-19 fears or reduced availability. Nearly 1 in 3 patients surveyed said they had to delay or forgo urgent care and 1 in 5 emergency care. Additionally, 16% of patients delayed or forwent preventative screenings, where underlying conditions can be detected early.
During 2020, nearly 1 billion total diagnostic visits that would have been expected in a normal year did not occur, with the greatest number in endocrinology, rheumatology, primary care and oncology. While numbers recovered some in 2021, patients are estimated to have attended 500 million fewer diagnostic visits than expected for the year. Some estimates show for breast cancer alone there could be 8,734 undetected cases, resulting in $27 million in treatment due to postponed diagnoses.,, Increased costs can impact patients and health systems, with more advanced treatments and procedures needed for worsening conditions. Additionally, those who miss screenings aren’t always flagged for a follow-up, especially without a way to consistently track where patients are receiving care.
Undiagnosed conditions could also affect prescriptions. In the first half of 2021, there were 15 million fewer new prescriptions than expected, with notable drops in oncology and pediatric prescriptions, at 21% and 26%, respectively. However, prescription volume began to recover in 2021, eventually eclipsing 2020 volumes and growth.
In situations where a prescriber wrote a prescription, many factors contributed to frequent delays in patients receiving medication. Over the last year, 82% of patients surveyed experienced delays in receiving medications due to COVID-19 restrictions, cost, insurance processes, communication issues and lack of transportation.
The burden of treating a patient population with more progressed conditions and catching up on other appointments could continue to strain the healthcare system as care teams address backlogged visits and progressed conditions.
Managing states of mind
On top of physical ailments, in the last 12 months, 66% of patients experienced an increase in anxiety, depression and/or insomnia. Over half of all patients surveyed started taking a prescription medication for one or more of these conditions. While this data speaks to the overall psychological toll pandemic effects have taken on patients, perhaps the silver lining is patient awareness and action on mental health.
Expanded telehealth options and a boom in digital behavioral health platforms have given patients more access than ever to mental healthcare. Over half of telehealth claims in 2021 were for mental health conditions. Mental health is also the largest category represented in disease-specific digital health apps, at 22% of the market. Receding regulatory action that helped expand telehealth access in the pandemic's early days could threaten a critical access line to mental healthcare when more patients than ever are seeking treatment. These include allowing providers to practice across state lines and reimbursement parity.
For patients managing multiple chronic conditions, continued access to mental and neurological health prescriptions can be crucial to improving their health. In one study, patients who were adherent to their antidepressants were also more likely to be adherent to their diabetes, cholesterol and blood pressure medications compared to those who weren’t adherent to their antidepressants.
Patients often need to address their mental health before they're able to focus on other health conditions or aspects of life. Continued progress in virtual mental health services and digital support for related prescriptions could benefit both patients' mental and physical health outcomes.
The caregiver burden
Worsening conditions and limited access to clinical care meant many Americans turned to family and friends for care needs over the last year. One in 5 adults reported providing unpaid care to an adult family member or friend, including medication management in 2020. This is an increase in approximately 9.5 million unpaid caregivers since 2015.
In turn, the extra time and tasks that come with caregiving can impact the health of those providing care. Seventy-seven percent of unpaid caregivers said providing support to friends or family members caused them to worry or stress, while half experienced worsening of their own mental health, 42% reported financial strain from missing work and over a third experienced a decline in physical health. Of all caregivers surveyed, 37% said they started taking a prescription medication for anxiety, depression and/or insomnia over the last 12 months. This means many were managing their own medication access challenges on top of those for whom they’re caring.
Care team burnout and shortages
With a healthcare system strained by unprecedented demands, more progressed disease states and an employee shortage, care teams in every setting face stress. In the last year, physicians and nurses experienced an increase in burnout, and many are leaving their careers due to the stress of the job and current conditions.
In a 2021 physician survey, 42% reported being burned out, with 69% reporting feeling depressed and 20% diagnosed with clinical depression. Many providers are feeling the strain of staff shortages, too. Healthcare jobs are down 524,000 since February 2020, with nursing and residential care facility employment down 421,000 as of December 2021. Nearly 1 in 5 healthcare workers have quit their job during this timeframe, while some have been fired or resigned over COVID-19 vaccine mandates.
The impact of this shortage on healthcare workers who remain is significant. Nearly 80% of healthcare workers said the shortages have affected their ability to deliver patient care, with 41% calling it a major impact.
While the Department of Health and Human Services has earmarked $100 million through the American Rescue Plan to help bolster the healthcare workforce, technology can help in the interim and the long run. Many solutions that automate historically manual processes, such as prior authorization (PA) and specialty medication support, can create more availability for staff to better address patients. Improved access and usability of data can further ease complexities affecting each role of the care team.
Improved interoperability and data access could further be a salve for pharmacist burnout. Pharmacists have been more recently involved in direct patient care duties, a role in which many find fulfillment. More than three-fourths of pharmacists now regularly give immunizations, 37% have newly taken on helping patients find affordability options, 42% now perform patient follow-up calls and 44% are managing a prescription home delivery program. With staffing shortages and a growing need for better data and automation at the pharmacy, many pharmacists, like providers, feel stretched thin. Fifty-four percent surveyed said they lack time to complete their job effectively — with the same percentage citing inadequate staffing as the most significant reason.
Diverse care locations and options
When it comes to primary care, community resources and pharmacies were able to narrow patient care gaps created by medical distancing and canceled or delayed medical office appointments. Compared to the previous year, more patients in 2021 visited alternate locations for minor illnesses and injuries, such as community health centers and local pharmacies. More also received primary care from nurse practitioners and pharmacists, a nod to the evolution and elevation of these roles on patient care teams.
Over a third of patients surveyed said they’ve relied more on their pharmacist in the last 12 months for information regarding their condition and medication, and 15% have received services unrelated to their medications such as testing and immunization.
Broader community-based healthcare, coordinated with health systems and specialists, has great potential to address common medication access barriers such as affordability and health literacy. Accessible, familiar sites of care could be more approachable and immediately available for a broader set of patients for preventative procedures such as vaccines and screenings. As healthcare payment models shift to become more outcomes- and value-based, sites of care already embedded in communities could play an important role in the future of healthcare. These shifts may further drive the need for transparent data and outcomes-focused metrics to keep patient care consistent and help improve interventions.
Digital momentum and inequities
While in-person visits are returning to normal levels, telehealth use remained 38 times higher than pre-COVID-19 pandemic levels in 2021. Patients are also now more often exercising use of digital prescription management options. Five percent more patients received their medications most often using an online pharmacy over the last year. While patients now have a wider range of options to access care and medications, work remains to make sure all patients can use these options. Regulatory pathways and greater data availability through payer and biopharma investment may also influence digital sustainability in healthcare, creating more opportunities for patient choice and access.
Regulatory and reimbursement challenges
Some states and governing organizations are now reinstating regulations that were lifted to allow broader telehealth access during the pandemic. These include physicians’ ability to practice across state lines and telehealth reimbursement parity.
1 in 4 Americans don’t have the technology, broadband access or digital literacy to participate in a virtual health visitDefining the digital divideAAHD
However, The Centers for Medicare and Medicaid (CMS) had given providers flexibility for telehealth and reimbursement for the duration of the declared COVID-19 public health emergency. Since these flexibilities went into effect, 1 in 4 Medicare beneficiaries have had a telehealth visit. Of those whose provider offered telehealth, the greatest shares of those taking part in telehealth were in communities of color, had low incomes, disabilities and/or multiple chronic conditions. Many legislators are pushing for these waivers and reimbursement policies to become permanent to expand telehealth availability and access. Some already have, including group psychotherapy services.
Providers are largely supportive of telehealth, but reimbursement rules may affect sentiments moving forward. In one survey, 54% of providers said they wouldn't provide virtual care if they were paid less for it than physical services. Federal CMS and exchange program regulations could provide models for state governments, which largely regulate commercial plans.
Providers also face their own technology access challenges. Many EHRs and other types of healthcare technology don’t have robust support for virtual visits, which can make it difficult for providers to connect with a patient on a screen while also documenting the visit properly. Technology challenges that persisted before the pandemic further complicate digital primary and urgent care. For instance, critical data and alerts are still exchanged through aging interfaces such as fax machines. Communication with patients and pharmacists is most often done via telephone, though most indicated they would prefer digital communication methods.
Access to digital healthcare resources varies
Telehealth and digital access to providers and pharmacists are part of the new baseline for health equity, but many patients are still at a disadvantage. While maybe not a top-listed social determinant of health, like food access and shelter, digital insecurity can have a broader effect on patients’ lives, especially with access to on-demand care, medication resources and their own health data.
While many have returned to in-person visits, virtual care is now an option for those too sick or without transportation to get to provider offices. Yet, 1 in 4 Americans don’t have the technology, broadband access or digital literacy to participate in a virtual visit.,
Aside from internet access, digital literacy — or the ability to effectively use technology — can also prove to be a barrier to healthcare. As technology itself advances, the bar for digital literacy raises, leaving more Americans behind in healthcare access. Healthcare organizations investing in digital solutions should also consider how to address patients with digital inequities. This could help address underserved patient populations and prevent greater gaps in social and physical health.
Widening medication access disparities
Expanded options for digital care and medication access helped address both needs and a demand for patient choice. However, the pandemic also threw open the curtains on unaddressed patient inequities and vulnerabilities, some of which have only worsened over the last 12 months.
When it comes to medication access, patient hardships persist. In the last year, over half of patients said they’ve made sacrifices to afford their medications — up by nearly 10 percentage points from 2020. Half have also had to forgo medications to pay for essential items and bills, up by 14% from 2020. And 56% have tried to make both work by stretching out or modifying treatment, up from 41% in 2020.
In the last 12 months, 79% of patients have gone to pick up their prescription and found out it cost more than they expected, up from 67% a year ago. Patients are exercising recently expanded options for affordable medication access. Ninety percent of patients in the last 12 months said they acted to better afford their medications, including talking to providers and pharmacists about affordability options, using copay and cash cards, switching to lower-priced alternatives and using patient assistance programs.
Pharmacists and providers may not always have answers to these questions, especially for uninsured patients or under-insured patients who may not hit their insurance deductible. The average single coverage annual deductible has increased 13% since 2016 and 68% in a decade, compared to core inflation increases of 11% and 23% in the same respective periods. Cash payment may be one of the best options for these patients, yet only 28% of providers and 47% of pharmacists can surface the cash price of a medication within their system., Fifty-two percent of pharmacists said cash discount cards are the most frequent affordability method they see patients using, followed by biopharma discount cards at 29%.
When patients exercised options to better afford medical care, a greater share opted to use telehealth appointments because of cost this year than last: 45% compared to 24%. Lack of access to resources could have affected those in lower income households. For patients in households making under $40,000 annually, 27% hadn’t participated in a telehealth appointment compared to 14% in households making over $40,000 annually.
For those attending appointments in person, transportation is a key factor in access. Transportation issues can lead to delayed or no-show medical appointments, missing medication pickups and therefore decreased adherence and inability to seek care for acute conditions. By relying on transportation methods such as public transit or a ride from friends or family, patients are more likely to experience unexpected variables in access to care.
In the last 12 months, 47% of patients surveyed used a form of transportation other than their own vehicle to get to medical appointments, compared to 39% of patients in 2020. Access to reliable transportation can impact timely healthcare. Most patients who said they experienced a delay in getting their medication due to transportation issues relied on alternative methods of transportation.
With greater data availability, providers could not only identify patients who may have transportation limitations, but also look for ways to reduce the need for transportation. Digital connections in prescribing software to available pharmacy programs, such as home delivery, digital pharmacies or affordability programs can help limit or even eliminate a patient’s need to travel to a pharmacy. Continued and strategic use of telehealth can also help reduce a patient’s transportation needs and, in turn, barriers to healthcare and medication access.
** Read Jzon's story for an account of how the COVID-19 pandemic affected his access to emergency and routine healthcare.**
The demand for accessible data
Healthcare doesn’t lack for data. Technology can seemingly store every transaction, keystroke, app login and procedure.
Broader datasets inclusive of social determinants of health can empower care teams to better address each patient's unique needs and treatment plan. This data, however, is often siloed and unrefined, creating information dams and complicated processes for patients and care teams.
The real value for patients lies in the ability for care teams and stakeholders to easily share and act on this data. Data liquidity, the ability for data to be entered once and flow and populate where it's needed, can promote more focused, productive conversations between patients and care teams. By surfacing only the necessary data at the right time, providers and pharmacists can more effectively accomplish shared decision-making with patients while finding efficiency.
Providers need patient-specific data
Providers are recently intaking more holistic patient data sets, with up to 80% surveyed asking patients about social determinants of health. However, unless they can act to positively impact patient outcomes, this data will go to waste. For example, if a provider knows a patient is unemployed and under- or uninsured, they may know the patient could have affordability challenges and better prepare patients with options to afford their medications — if this data is available.
Ninety-one percent of providers surveyed said they discuss medication affordability with patients, with 42% initiating the discussion no matter the patient’s financial status. However, half of providers are holding these discussions only when they think a patient may have financial concerns from themselves or if a patient voices them. Without reliable patient- or drug-specific cost information easily accessible, from direct connections to payers and pharmacies, these are likely to be unproductive conversations.
In a recent study, only 21% of prescribers could accurately estimate patient out-of-pocket costs without full information sets on patient benefit information and insurance cost-sharing. Solutions equipped with accurate, real-time prescription costs can help patients arrive at the pharmacy with confidence in their medication and financial plan of action.
When asked about prescribing features available within their EHR, 68% of providers had medication-specific information and 57% had plan formulary alternatives available. However, a quarter or less of providers had plan-specific cost, patient deductible information or pharmacy-specific pricing within their EHR.
Lack of patient-specific data in care team workflow can leave patient questions unanswered, leading to lack of understanding and sticker shock at the pharmacy. Forty-seven percent of patients surveyed within the last 12 months said their provider discussed the cost of their medication with them, yet a staggering 79% of patients said they’ve gone to the pharmacy and found out a prescription cost more than they expected.
Some of this sticker shock could be attributed to patients who didn’t discuss out-of-pocket costs with their provider at the point of prescribing. For those who did, research shows patients forget half or more of the information discussed during a provider encounter, with recall ability affected by education level and age., Accessible data about prescription cost and information in patient-facing technology could help patients better recall and reference information discussed during an appointment. Stakeholders such as payers and biopharmaceutical companies could find better partnerships with providers and patients by leaning in to transparent, easily shareable data exchanges. This can then allow providers to share information in a way patients consume it best — via apps, portals, printed discharge notes or phone calls.
Transparency is key for patient decision-making
When it comes to prescribing, providers have to keep up with constantly changing medication cost and coverage on top of new, complex, high-cost medications. To keep up, care teams need direct, real-time updates within workflow to facilitate shared medication decision making with patients. PBM formularies change annually and can be modified by individual health plans and insurers. Additionally, since the practice began, the number of unique formulary exclusions has grown substantially each year — from 109 in 2014 to 846 products in 2020 within the largest three PBMs in the country.
Commonly excluded from formularies are single-source brand-name therapies, which made up 41% of medications excluded from top formularies for at least one year between 2014 and 2020.Historic growth in the number of specialty medications coming on the market have pharmacy benefit managers (PBMs) shifting to develop formulary criteria for these therapies, including exclusions, step therapy and separate formulary tiers. On top of these nuances are Medicare Part D formularies, which are permitted drug exclusions, unlike Medicaid plans.
Open, transparent connections among the healthcare ecosystem can help all stakeholders stay on top of changes and criteria needed to help patients access and afford their medications, even as plans change year to year.
Recent and forthcoming regulations may help release the data dam
Practices such as information blocking, interference in the exchange or use of electronic health information, can impede timely access to data that can help manage patient health conditions and coordinate care. Information blocking can be outright, but often subtle, through organizational policies or limitations that make sharing information overly time-consuming or costly.
Recent legislation and regulations, including those within the Office of the National Coordinator (ONC) and Centers for Medicare & Medicaid Final Rules, stand to accelerate data exchange and transparency within the next five years., Information blocking rules that went into effect this year can allow patients greater access to their own health records and choice in how they use them within health apps and devices.
While the future is bright, there are likely still challenges to come as outside digital organizations could face legal and privacy issues related to how data is shared among companies and entities. Standards development organizations such as the National Council for Prescription Drug Programs (NCPDP) and Health Level Seven (HL7) will likely play key roles in creating regulatory channels to maintain the open sharing of data in standardized, safe methods among stakeholders.
Further progress in interoperability at the health system level and beyond will likely come with the rollout of the ONC’s Trusted Exchange Framework and Common Agreement (TEFCA) in 2022. TEFCA will establish a single method for hospitals, health systems and providers to exchange information securely. For providers, TEFCA will allow information exchange through a single method. Pharmacies also benefit from the TEFCA health information exchange through easy access to data to improve drug-interaction checks, including ICD10, allergies, health conditions, SDOH and provider visit notes.
While 92% of the U.S. population is covered by an HIE, hospitals and care systems in rural areas are half as likely to share records, but likely stand to benefit the most from data exchange. Social determinants of health data could help identify risk factors for patients with lack of access to nearby providers and pharmacies and easily connect them to service organizations within the community. Of patients who experienced a delay in getting medication over the past year, 26% were due to affordability issues and 6% due to lack of transportation. Integrating data and service referral processes within workflow for providers can ease their administrative burden and further improve patient outcomes and medication adherence, benefiting the dawn of value-based infrastructure.
Unimpeded data flow to the pharmacy
Ideal medication access data flow should continue downstream to the pharmacy, providing an even wider watershed to address patient affordability and adherence. Unfortunately, the interoperability conversation often comes to a hush at the pharmacy. But the growth of the pharmacist’s role on the patient care team will amplify the call for patient-specific data at the pharmacy.
Expanded roles and limited resources
In the last two years, pharmacists have become beacons of trust, hope and healthcare security. Their roles expanded to fill gaps in primary care, vaccine administration and medication and care counseling, which many in the profession have pushed for since before the COVID-19 pandemic. Over a third of patients surveyed said they’ve relied more on their pharmacist in the last 12 months to provide condition and medication information as well as explain benefit and payment options. Fifteen percent said they’ve relied more on their pharmacist for services unrelated to their prescriptions such as immunizations and testing.
Patient-facing duties are what pharmacy staff ranked as most fulfilling during perhaps the most demanding time of their careers. When asked about their single most fulfilling job component, an overwhelming majority chose counseling patients on their medications. Unfortunately, for them and for patients, twin blights of inadequate staffing and lack of data within workflow often limit meaningful patient interactions.
Fifty-four percent of pharmacists surveyed said most days they don’t have time to complete their job effectively: 81% cited inadequate staffing, 73% administrative tasks and 55% an overemphasis on metrics.
In a recent survey, 68% of pharmacy owners and managers said they were having a difficult time filling positions, with 88% noting pharmacy technicians were the most difficult role to fill. Yet they’re greatly needed. In 2020, the Department of Health and Human Services authorized pharmacy technicians to perform vaccinations under the surveillance of a licensed pharmacist. Allowing pharmacy technicians to take vaccination workflow allows licensed pharmacists to perform prescription-related duties and patient counseling.
Opportunities for automation and integration
While staffing shortages will likely need to be addressed through systemic changes on a state-by-state and even pharmacy-by-pharmacy basis, interoperable technology could help staff address and overcome medication access barriers with patients in a timely manner.
While providers are holding medication affordability conversations, patients also rely on pharmacists to help resolve financial and access barriers. When patients found out their medication cost more than expected, nearly a third then leaned on their pharmacist to provide a cash price or cheaper alternatives. Multiple prescriptions, insurance processes and even copay accumulator programs can complicate the medication access process, especially when these issues aren't or can't be addressed at the point of prescribing.
In a given week, 84% of pharmacists said they're helping patients with benefit questions, with the most time spent on helping patients understand their coverage and finding discount programs or coupons. Most are likely having to search multiple places to help find this information. Only 36% of pharmacists said they have patient-specific benefit information in their system, and just 41% can surface manufacturer discount card options.
Beyond the availability of this information, clarity in the data presented can further help pharmacists address patient concerns and get ahead of adherence issues for refills and later prescriptions. Details such as first-fill-only coupons, deductible-applied discounts and multiple prescription costs can help pharmacists hold more proactive conversations with patients, so they have clearer expectations for their treatment.
To address over one-third of patients who rely more on pharmacists for medication-specific information, pharmacists need more answers integrated within their system. Three-fourths of pharmacists surveyed said they’re going outside their system daily to look up medication information. Direct connections with biopharmaceutical companies could help surface this information, along with connections to educational materials and discount programs.
Pharmacists need more clinical data at hand
As pharmacists perform more clinical duties, they'll benefit from access to more complete sets of patient health data. Aside from primary care, knowing a patient has a history of cancer or a transplant, for example, could help pharmacists make dosing and medication interaction recommendations.
Only 60% of pharmacists have patient diagnoses listed in their system and just 21% have procedure history. This data could help expand the continuity of care for patients and create efficiencies in other areas of the healthcare ecosystem. In turn, sharing data collected at the pharmacy could also help provide the greater patient care team with a 360-degree view of the patient and collect information that may have been missed or not surfaced at other appointments.
Electronic, efficient communication among stakeholders
Because pharmacists are the caregiver most often resolving medication access issues, they’re also in need of efficient communication methods to gather necessary information from patients, providers and payers.
Resolving issues such as prior authorization (PA), prescribing errors and medication switches due to financial concerns often requires contacting providers offices. Pharmacists are frequently contacting providers offices through manual processes, with 75% using phones and 58% faxes. Just over half can contact providers offices through their pharmacy system, though not all can use this method exclusively. When asked what preferred primary method they would use to contact providers offices, only 14% of pharmacists chose via phone, with 67% preferring to contact providers through their pharmacy system.
Both pharmacists and providers indicated a preference for electronic communication with patients.
The majority of providers, 62%, are communicating with patients most often through a phone call outside of appointments. While 32% are most frequently using patient portals for communication, 53% of providers said they would prefer patient portals to be their primary method of patient communication.
Nearly all pharmacy settings indicated a preference for text message exchanges with patients, with 37% saying this was their top choice for patient communication.
The majority of pharmacists, 72%, are most often communicating with patients in person at the pharmacy.Chain retail pharmacies were more likely to use electronic methods, with 77% using a text message system, compared to 52% overall, and 50% using a pharmacy app compared with 30% overall. Specialty pharmacies were the only group using phone calls more often than all other methods.
Diversity in patient pharmacy interaction methods will likely drive a need for pharmacists to communicate with patients in a variety of methods. Use of local pharmacy delivery programs increased from 13% in 2020 to 21% in 2021., Patients using these services and mail order pharmacies likely need digital communication methods.
To serve a diverse patient population with varying needs, patients need choice in their communication methods with care team members. Pharmacists and providers need workflow options that keep them in their systems as much as possible.
Meeting expectations for speed and convenience
According to a recent study, most patients want shareable access to their health data. In 2021, most patients had it. Ninety percent of patients surveyed said they have electronic access to medical labs, tests and data through a patient portal and 86% said they could easily share this with their care teams if needed. Two-way data sharing — especially related to social determinants of health data — with providers and pharmacists can help fill in lifestyle data that affects patient health alongside clinical factors.
Receiving healthcare anywhere may be a new paradigm, with momentum gained during pandemic-related digital shifts moving progress forward. Health history and data should follow the patient, no matter where they are in the care setting. This requires interoperable systems to transport and interpret this data so patients, pharmacists and other stakeholders can access it and most effectively perform their role in the care continuum.
During the pandemic, health systems showed incredible resilience in restructuring existing systems to most efficiently treat — and save — the most patients possible. These shifts came with reporting large data sets and partnering with local health information exchanges. Data sharing at the local level showed encouraging improvements and patient outcomes in relation to COVID-19.
Now, these information exchange networks need to connect and communicate on a national level. Health systems and offices can continue building on the efficiencies found in the last two years. And as the industry moves forward, providing efficient, and even proactive, care and continuing to share public health data will be necessary to enable the shift to outcomes- and value-based care models. This national expansion can allow providers to make clinical and prescribing decisions for patients based on timely, condition-specific data. But to act on it, they need better workflows and real-time data at the point of prescribing.
** Read Patrick's story to learn how data accessibility could benefit patients who want quick access to their care team and health information.**
Complex medication access paths
Medication access journeys are often complex, with unpredictable turns. This is especially true when it comes to diagnoses that require specialty medications.
These complex medications are often harder to access and more expensive to afford. A tangle of verification and billing processes for some medications can also lead to delays in therapy, while patients experience worsening symptoms and conditions in the interim. If patients have to take off work to go to the pharmacy or provider’s office multiple times, they can also experience financial hardship.
Of patients who experienced any delay in receiving medication in the past 12 months, 85% had to make financial sacrifices this year related to medications, either forgoing bills or medications or modifying treatment to stretch out prescriptions. This is compared to patients who didn’t experience delays, with only 33% of this group making the same sacrifices.
Because of these variances, the best solutions for navigating web-like medication access courses combine human intervention and technology.
Workflow-integrated, role-specific solutions for the entire care team can help ensure transparent, efficient care continuance. Whether seeking PA for a retail medication or navigating patient support services for a specialty medication journey, patients deserve the quickest time to therapy possible and to feel supported along the way. Such solutions can help patients experience up to a 34% reduction in time to therapy.
The right solution for each role
Team-based solutions should share data and execute tasks specific to various roles to form one, fluid story of a patient’s medication access journey. The larger issue for care team solutions is no longer gathering data — it’s making sure real-time, relevant data are easily accessible and accurate.
While many healthcare technologies were built to help automate previously manual processes, the increasing computerization of practices has actually led to increased burnout for 28% of physicians.
To help avoid alert fatigue and information overload that can lead to burnout, team members need role-specific, highly capable technology to surface the right information at the right time. While prescribers are often making the final medication decision, with patient involvement, 97% of nurses are informing prescribers with patient and medication information that influences this decision. This information most often includes PA requirements, previously tried and failed medications as well as information about the medication itself. For 73% of nurses, this information isn’t located in a single source, meaning they’re spending time and energy tracking it down in multiple places like online resources.
Rather than adding a new solution to workflow for each role or task, integrating existing solutions, such as medication reference solutions for nurses and clinical documentation specialized technology for prescribers, can create efficiencies that allow care teams time to connect with patients.
When asked which feature would be the single most valuable of those not currently within their EHR, providers most often selected patient-specific benefit information. While this information can be sourced in several ways, direct connections to PBMs and payers could best improve provider trust and patient education.
These direct connections, as well as biopharma information, could help improve provider awareness of new drugs, recalls, drug combinations and formulary switches to relieve a weight on the health system as a whole. These connections further stand to help patients by including information such as copay cards and patient education materials directly accessed withing EHRs and portals.
Prior authorization workflows
Integrated workflows are additionally important when it comes to approval processes such as PA. The sustainability of telehealth use could further weaken the case for manual PA request management and increase the need for surfacing PA requests at the point of prescribing. Patients pay the price for this waiting game: 29% have experienced a delay in getting their medication in the last year due to insurance processes and provider communication delays.
Delays due to PA can create particularly dire situations for patients with diseases such as cancer, which is seeing growth in oral prescriptions, more likely to go through pharmacy benefit and taken at home. About 72% of oral oncology drugs require PA, which delayed patients by a median time of seven days. One in 4 patients had to wait at least 14 days to receive their medications.
Proactive, integrated PA solutions can help patients start therapy sooner, and improvements start at the point of prescribing.
While only 25% of providers say they start PA requests during prescribing within their EHR, this is an increase of 18 percentage points over 2019, marking significant improvements in technology adoption and capabilities in two years., Greater adoption of integrated ePA technology can help patients receive medications 13.2 days sooner when their prescribers submit PA requests prospectively compared to submitting after the pharmacy has notified them a PA is needed.
Despite an increase in prospective PA request initiation, providers are most often starting PA requests after the pharmacy has notified them a PA is necessary. When contacting providers offices, the PA management workflow for pharmacists is time-consuming and manual. Behind inadequate staffing, the second-most significant reason pharmacists don’t have time to perform their job effectively is administrative tasks, including PA. Seventy-seven percent of pharmacists are most frequently communicating with providers about rejected medications, and they’re usually doing so through phone and fax — and sometimes both. Pharmacists using an integrated solution, including real-time PA status updates, saw a 14% increase in paid claims, on average, helping more patients with primary and sustained medication adherence.
Pharmacy considerations for specialty medications
The possibilities for holistic patient care and the need for further automation persist at the pharmacy. To control coordination of specialty medications, some companies require medications to go through a limited distribution network (LDN), which identifies a narrow field of pharmacies allowed to distribute the medication. About 85% of biopharma companies manage some or all of their products through an LDN. While intended to help control costs and keep connections closer, LDNs can also delay medication access, sometimes by twice as much as non-LDN drugs. Biologics, cell and gene therapies entering the market can further complicate the journey and increase the need for pharmacists to have data within their pharmacy system.
LDNs, however, can allow biopharma companies to better aid patients in adherence efforts with complex therapies by ensuring the distributing pharmacy has clinical expertise in a certain condition or patient population and can help with medication administration and adherence. Connections through hub programs can help patients and care teams more quickly know that a medication is distributed through an LDN and further speed the access process to LDN drugs.
Just as with provider care teams, manual processes can contribute to workflow inefficiencies for pharmacies handling specialty medications. More than 40% of faxed specialty prescriptions require a call back to the provider, possibly because more than 85% of providers said they lack digital access to specialty pharmacy information within their EHR systems., Interoperable solutions could help with these manual processes, and especially alleviate overworked specialty pharmacists, 41% of whom cited inadequate staffing as a reason for inadequate time during the workday, the same percent that cited administrative tasks as a reason.
Specialty medication dashboards in pharmacies can help centralize and standardize specialty medication processes. These services and tools can give pharmacists, especially those in specialty pharmacies, opportunities to provide more value-added care for their patients beyond drug dispensing. Patients are shown to be increasingly reliant on specialty pharmacies for services such as information about their condition, side effect management and training on medication administration. These services, including help finding affordability programs, can have a measurable impact on patient medication adherence.
As value-based systems extend to the pharmacy, patient data related to adherence, outcomes and formulary compliance could be critical in the business health of pharmacies. Solutions that can track, store and suggest action on these data can continue helping pharmacies thrive in the future healthcare ecosystem.
Growth of utilization management tools
To manage specialty medication costs and reduce waste, payers and PBMs employ utilization management (UM) services at the point of prescribing. These include PA, step therapy, quantity limits and drug utilization reviews. With the recent specialty market growth, accounting for over half of the total drug spend in 2020, UM tools have also grown in use. In 2020, at least 80% of employee-sponsored health plans used PA, step therapy and quantity limits for specialty drugs, all of which have increased in frequency since 2016. In one study of UM effects on patients, it took an average of 30 days for patients to receive approval for the original drug their provider prescribed. However, the average time between patients’ first and last attempt to fill a prescription before deciding to stop trying was 17 to 23 days. In short, barriers to timely treatment can prevent many patients from receiving treatment at all.
In relation to step therapy specifically, 40% of patients stopped taking medicines they were forced to step through that did not help and 27% stopped taking medicines because the insurance company did not pay for them.
In the same survey, 87% of providers and 56% of pharmacists surveyed said UM methods prevent patients from receiving treatments that could help them most. Pharmacists are also most often taking on the task of managing medications denied due to step-therapy policies. Pharmacists surveyed spend at least 20% of their time managing denied medications due to step therapy, with some spending up to 80% of their time on this task.
Specialty-specific hub solutions could help care teams get ahead by understanding patient-specific plan requirements. While these requirements are likely to impact most specialty medications providers prescribe, only 51% felt they had the necessary benefits information to start patients on these medications.
Interoperability and real-time transparency can help providers manage the requirements of these UM services to help start patients on complex therapies faster.
Solutions for complex medications
Specialty dashboards and tech-enabled hub services can electronically enroll patients before they leave their provider appointment. Early enrollment allows each care team member and stakeholder, from nurses to care coordinators and even community specialists, to start their tasks sooner.
Visibility is critical in these solutions. Care team members need to see previous encounter notes and pharmacists can benefit from understanding patient medical history and prescribing data. When asked what features within a specialty platform would be most helpful, providers’ top answers were total visibility into case work and the ability to complete reimbursement processes electronically.
In turn, patients benefit: In some cases, an electronic patient support hub contributed to a 34% reduction in time to therapy. Real-time visibility can also allow various providers and specialists to keep stakeholder communication consistent and further save time through avoiding redundant procedures and processes.
** Read Kristy's story for a real-life account of complex medication access paths she's taken to treat primary myelofibrosis.**
Transparent, accessible data lay a trustworthy foundation for value-based care models. Improving patient outcomes is vital to these systems.
Interoperable solutions will likely be critical to keeping value-based systems effective and care teams addressing all patient needs. Care team and pharmacy solutions can find an additional layer of value through two-way, and even multi-way, communication. As patients play a larger role in managing their own health and reporting their information, the need for understandable, accessible and culturally competent healthcare information grows. Technology can help free time for human connections to turn the tide on a more accessible future for patients.
Equitable — not just equal — medication access
No treatment plan is the same, and just as patient biological needs differ, so do their social, financial and wellness needs
Flexible care models
While healthcare is becoming increasingly digital, with great momentum gained in the last two years, not all patients receive care best through screens and apps, or even have access to them. To combat this, some health systems have started technology access programs, such as giving out loaner devices, that allow patients to use the devices for non-medical needs such as schoolwork or searching for a job., This access can have compounding effects for patient quality of life and outcomes.
Additionally, by adding SDOH screening questions to digital patient risk assessments, care teams can better understand the needs of their patient populations and address them accordingly. Some patients may simply prefer or need to do telehealth appointments over the phone instead of through a digital device that requires an internet connection.
Asynchronous care models can further reach patients who may work odd shifts or have trouble finding childcare, for example. This model helps providers gather patient data and make informed decisions, while patients can see their care team at their convenience and possibly even save time: Compared to synchronous telehealth visits, asynchronous visits can save care teams and patients up to 17 minutes. Asynchronous care is also being used as a way to address care team burnout due to its efficiencies. To become a sustainable model, like traditional telehealth, and gain greater provider adoption, reimbursement models in each state will likely need to find paths for parity.
Integrated connections to support services
Out-of-pocket costs may be the most common barrier to patient medication adherence, but myriad factors can influence whether a patient has the transportation, finances or time to access their needed medications. For many with limited resources, patients must choose between their medications and household living expenses. At the time of prescribing, especially for specialty medications, patient-centered solutions should allow providers and navigators to connect patients to supportive services. This may include biopharma-sponsored or charitable financial assistance and community health resources. Additionally, federal and state safety net programs like SNAP, TANF and Medicare assistance can play a critical role in helping patients, but many patients may not be aware of their existence or eligibility.
Technology inclusive of connections to non-clinical services can provide a warm handoff to human intervention such as navigators and coordinators. Likewise, referrals to adherence expertise can help patients better understand their condition and maintain their individual treatment plan. These services can help patients increase therapy adherence by 25%, spending an additional 31 days on therapy in some cases.
Patients may also find improved health outcomes through help in other areas of life. In one survey, 63% of patients said the thought of financial distress resulting from healthcare and medication bills is more distressing than the possibility of death. Non-clinical needs navigation can help patients access programs within their community that provide food, transportation, financial care planning and even workplace services and support. Screening for these risk factors in predetermined workflows is a start to helping patients but scaling this solution and measuring outcomes could truly impact greater public health and medication access.
Health literacy impacts patient outcomes
Patients seek out more health, cost and coverage information each day to make informed choices and rely on their providers and the internet for guidance. Google estimates it gets 1 billion health-related searches a day, comprising about 7% of its daily searches, or 70,000 a minute. Further, half of patients perform online searches for healthcare information before and after diagnoses and during treatment. Patients’ ability to comprehend this information may be limited and could hinder their outcomes. An estimated 15 to 27% of the U.S. population has limited health literacy. Seniors, who take more medications and manage more chronic conditions than any age group, also have the lowest health literacy of all age groups. This disparity can have a direct impact on health. Seniors in counties with the highest health literacy experienced 26 fewer avoidable hospitalizations and 13% lower costs per Medicare beneficiary.
Importantly, patients consider costs of care and the impacts on their financial well-being as the basis of every healthcare decision they make. Medical terminology is rarely intuitive for patients, and the specialized lexicon is unfamiliar without years of exposure to the various terms, what they mean and how they affect ability to access care. Health literacy and cultural competency challenges further compound gaps in information that patients need to make the best healthcare choices for them.
To address patients with varying levels of health literacy, and help improve population health literacy, healthcare stakeholders should consider a multivariate approach to distributing patient information. Digital patient tools can be designed with glossaries, icons that point up and down to better communicate test results and direct connections to biopharma companies for information on conditions and medications. Providers and care teams can test communications before they’re distributed and consider teach-back methods, visual cues and even language barriers based on their patient population. Here again, data can drive outcomes through a better understanding of the individual and population-level patient needs.
These efforts can help patients navigate a confusing, matrixed healthcare environment where healthcare and home care converge.
More than 90,000 digital health apps entered the consumer market in 2020, with a total of 350,000 total available. While the trends began with fitness and wellness, health condition management now makes up nearly half of all health apps, up from 28% in 2015. Digital therapeutics, which require FDA approval, now comprise at least 25 products with granted market authorization through regulatory, with most addressing mental health and behavior modification.
Small, interconnected devices have created an internet of medical things, and with the introduction of new legislation allowing patients to download their healthcare data and use it in various applications, the industry can benefit by connecting the dots among data sources.,
Monitoring devices and prescription digital therapeutics can allow providers and pharmacists to address patient medication adherence and effectiveness on an ongoing basis, allowing acute, manageable adjustments instead of treatment plan overhauls. By integrating big data with patient-level data, care teams can help determine and even predict patient outcomes to develop early intervention plans on a population level. The future of healthcare and medication access lies more in the convergence rather than the development of technology.
** Read Marley's story to learn how solutions that take patient choice into account have allowed her to define her life beyond the realm of a cancer patient.**
Shifts in technology and systems of care can be expensive and time-consuming. But more costly is patients suffering due to system inefficiencies and outdated processes.
The healthcare system can’t afford not to address patients holistically because too many patients can’t afford to be sick — financially or holistically.
Momentum generated through 2021 has drastically shifted and diversified the ways patients receive their medication. The COVID-19 pandemic forced an acceleration of change toward less manual, and more technology-supported interactions. However, without collaborative effort from all stakeholders, the healthcare industry could struggle to enable this future state.
Expanding affordability opportunities
With electronic coupons, expanded digital access to providers and patient affordability programs, patients seemingly have more options than ever to help lower their medication out-of-pocket costs. Yet, 79% of patients in the last 12 months still found out their prescription cost more than expected at the pharmacy. Creating a financial game plan for medications doesn’t have to be a one-shot opportunity in the patient journey, especially when paths to medication access are often non-linear. Patients are now diversifying where and when they receive care, which means they need options at the point of prescribing, from every possible provider and at the pharmacy. To avoid confusion and ensure a patient has their best chance at affording their medication, these options should also be transparently communicated and integrated among EHRs, pharmacy systems and patient-accessible technology.
Data liquidity can support shared decision-making between patients and care team members while easing pain points and increasing efficiency.
Payers can best serve patients by offering price transparency and accessible, understandable methods of interpreting their coverage. Biopharma can further reach patients through assistance programs and their providers, in multichannel education and outreach programs to help improve patient health literacy and outcomes.
Mitigating various access barriers
Beyond affordability, patients and care teams can benefit from technology that helps automate medication access verification and authorization processes. In the last 12 months, 82% of patients have experienced a delay in receiving their medications. Reasons for this are due to access challenges both administrative and physical in nature.
For administrative access challenges, providers and pharmacists may have electronic solutions to manage PA and benefits verification, but not enough have these functions in their current workflow. The hours per patient these technologies could save is even more impactful with staffing shortages affecting the broader healthcare industry and projected to only increase through at least 2026.
Integrated ePA solutions within EHRs and pharmacy systems can enable proactive PA submission for providers and real-time updates for pharmacists. When providers start PA requests at the point of prescribing, patients can get their medications nearly two weeks sooner, on average, compared to requests started at the pharmacy. For specialty medications, which can come with a separate slate of access hurdles, integrated solutions can help patients access these critical therapies faster. By integrating electronic processes into traditionally manual workflows, patients can experience a 34% reduction in time to therapy.
Just over half of pharmacists can receive PA status updates within their current system, and likely find it the most useful feature in it. Pharmacists ranked checking the status of a PA request as the feature they'd most value but don’t have in their current system. Pharmacists using an integrated solution, including real-time PA status updates, saw a 14% increase in paid claims, on average.
Physical access challenges can also be overcome with help from technology solutions. Digital connections can help providers meet patient needs when it comes to transportation limitations, technology inequities and environment challenges better access the care and medications they need.
Supporting crisis-proof medication adherence
Finding the right therapy for each patient should be a partnership between care teams and patients, aided by the right solution at the right time. Maintaining medication access, past the first fill, can come with its own set of challenges. Variables later in the patient journey including co-pay accumulators, renewal challenges, formulary changes and social determinants of health can interrupt therapy maintenance and affect patient health. Ensuring seamless medication adherence is a key advantage in improving patient outcomes. Electronic patient support services can bridge barrier gaps to improve patient adherence through automatic enrollment in specialty hubs, expedited benefit verification and PA processes and improved access to specialty pharmacies. Often, though, when it comes to adherence challenges, human intervention is the best approach. This is why available technology to automate manual processes is important — to allow care team members to focus tasks that hold the most value in patient care. Clinical support to help patients with treatment, side effects monitoring and drug-specific nuances can help patients experience a 25% increase in therapy adherence and 31 more days on therapy. Field-based product training can also help fill educational and practical gaps to improve therapy adherence. Patient-centricity is critical for adherence success, and consumer technology as well as connections to valuable, community and humanity-based resources have key roles to play in this future.
The future of true healthcare
Since March 2020, health systems have demonstrated an incredible ability to stretch and flex, accommodating patient surges and an unfamiliar disease and embracing leaps forward in technology. Post-pandemic, rather than snapping back into place like a rubber band, the industry could spring forward by using newfound workflows to better navigate patient care.
The industry sits on a precipice of tipping the needle from reactive sick care to truly proactive healthcare. The convergence of technology can create efficiencies to advance patient outcomes, enable affordable healthcare and sustain medication adherence so patients can continue to live their healthiest lives in 2022 and beyond.
The Medication Access Report is developed in consultation with an advisory board of healthcare experts representing major organizations across the industry — each with unique perspectives, interests and opinions.
Marc Allgood Director, Pharmacy Systems & Process Redesign, Albertsons Companies
Kerry Bendel Chief Pharmacy Officer, Cambia Health
Nicole Braccio, Pharm.D. Director of Policy, National Patient Advocate Foundation
Nick Calla Senior Vice President, Industry Relations, Orsini Specialty Pharmacy
Steven Chao, M.D., Ph.D. ClearView Healthcare Partners
Liz Helms President & Chief Executive Officer, California Chronic Care Coalition
Josh Howland Vice President, Clinical Strategy, PioneerRx
Patrick McGill, M.D. Executive Vice President, Chief Analytics Officer, Community Health Network
Milisa Rizer, M.D. Chief Medical Information Officer, The Ohio State University Wexner Medical Center
Susan Shiff President, Ontada
Judy Sorio Director, ePrescribing Services Development, Cerner Corporation
Lee Ann Stember President & Chief Executive Officer, National Council for Prescription Drug Programs
Eric Weidmann, M.D. Chief Medical Officer, eMDs
Joel White President & Chief Executive Officer, Horizon Government Affairs