The Challenge of Getting Approval for Specialty Drug Therapies and Referrals

One of the roles of specialty pharmacy is to deliver potentially life-altering and often complex therapies as quickly as possible. However, in the industry’s current state, many specialty pharmacies experience lengthy, drawn-out, and complicated approvals that traverse various stakeholders with unique needs and requirements, multiple systems, and different people at different stages of the referral process

From the prescriber to fulfillment, the referral process is subject to a number of exceptions and decision trees, typically containing multiple stages and passing through the hands of several entities. Intake, benefits investigation, prior authorization, financial assistance, and any denials and appeals may all be further complicated when one or more entities use fax transmissions that must be manually entered into a database to be passed along to the next entity.

To streamline the process, preserve data integrity, and ensure that each patient receives critical treatment in a timely manner, today’s specialty pharmacy can enlist the help of specialized tools and technology that help patient care coordinators and benefit investigators manage the referral process.

Every pharmacy stakeholder encounters many challenges in the current referral process.

Referral Process Challenges

The approval procedure differs significantly depending on a unique mix of the prescriber, pharmacy, payer, plan, and manufacturer needs.

Common challenges often include:

• Ambiguity in referral status, which often occurs from disparate, unconnected solutions
• Inability to seamlessly integrate with current systems, processes, and workflows
• An influx in forms and paperwork that may be filled out by hand and entered into one or more systems
• Data integrity compromise from manual entry mistakes, double-entry, lost or misplaced documents, and other human errors
• A lack of organization and tracking that can lead to difficulty when reporting to key stakeholders

CPS is here to help make specialty pharmacy easier.

TherigySTM's specialty therapy management platform makes the referral process automated, easier, and more efficient.

To help specialty pharmacies, TherigySTM customers referral management solution works to simplify the referral process, expedite each patient’s time to therapy, and ultimately improve outcomes. This feature increases the visibility and integrity of data while improving communication and reporting between team members and stakeholders.

Key features include:

• Integration with your existing workflow and solutions
• Clear task structure with start and end times to facilitate communication
• Status updates, tracking, and timeframe-specific reporting
• Collaboration between multiple users on multiple systems
• Robust data capture, and reporting for improved management of the onboarding process

CPS is committed to creating more value for its customers.