Marc Duey, MSc, MBA, president, ProMetrics

It is important to measure speed-to-therapy for specialty drugs to evaluate how much time it takes manufacturers, physicians, insurance companies, hubs, and specialty pharmacies to get essential medications to patients.

Numerous stakeholders are involved in the patient journey; among them are manufacturers, physicians, insurance companies, hubs, and specialty pharmacies (SPs). It is important to measure speed-to-therapy (or time-to-fill) to evaluate the success of these stakeholders in ensuring that patients are receiving essential medications on time. Clearly, patients benefit from better service and earlier treatment of life-threatening diseases. In measuring speed-to-therapy, numerous causes of delay that contribute to the elapsed time-to-fill must be considered. It is in our best interest to understand the causes of these delays, prioritize them, and develop strategies to reduce their impact. The purpose of this survey is to identify problem areas as they relate to speed-to-therapy.

One hundred five participants completed the survey from companies such as Walgreens, Bayer, Diplomat, Teva, Pfizer, and many more. Here are notes about the process:

		The main distribution method for the survey was by e-mail to several hundred industry experts.

		Among the respondents, many were attendees at the speed-to-therapy conference hosted by CBI.

		Approximately 75% of survey participants had more than 10 years of experience in the industry.

		Respondents represented a wide variety of professional organizations and functions.

While many therapeutic classes were represented in the data, about a third of the contributors chose to focus on an oncology product that was on the market for fewer than 7 years.

Time-to-fill explains how quickly a patient initiates therapy after the SP receives a prescription. It must be noted that time-to-fill depends on the type of therapeutic product, whether the prescription was a new prescription or a refill, and if the product is new to the market. The survey results are as follows:

		The participants were provided category choices grouped into major therapeutic areas as shown in the “Therapeutic Class” graph. Only 33% of survey participants agreed that the product they chose was behind industry standard in performance for time-to-therapy; however, more than 70% of participants agreed that significant improvements need to be made in time-to-therapy performance.

		The median time-to-fill among BioPharma respondents was 9 days compared with only 4 days for SP respondents.

		74% of estimates were filled in fewer than 10 days, but 8 responses indicating it took a maximum 20 days for time-to-fill demonstrates there is an issue.

A certain number of delays are natural in the course of business; however, it is unacceptable to believe that the process cannot be improved. The top 3 perceived main delays were manual prior authorizations, missing or inaccurate information on forms, and inefficiencies related to the manufacturer hub referral process. A deeper look at the data suggests that prior authorization issues are most readily detected, accounting for nearly half of the delays.

The experiences and perspectives from BioPharma and SP industry veterans were collected and analyzed. The following insights were derived from the data:

		Oncology products most often come to mind (in terms of concerns with time-to-fill) when discussing the SP space and serving patients.

		For oncology products, the entire product life-cycle is represented and in roughly equal proportions, as evidenced by the responses in the “Time on Market” graph.

		Most respondents (70%) felt that there is room for improvement in speed-to-therapy.

		Most respondents (74%) reported a reasonable time-to-fill for all specialty products, but a large number of delays were reported.

		Nearly half (48%) of delays were caused by the prior authorization process and were blamed nearly equally on the physician and the payer.

		Missing patient information was often attributed to human error and/or omission.

Technology is being underutilized in the capture and transfer of data critical to driving fast speed-to-therapy times. Software and programs for e-enrollment and e-prior authorization are being used by only one-third to one-fifth of respondents. Many use no such electronic systems at all.

Adoption of electronic systems and current best practices can improve prior authorization by making the process faster and easier. Furthermore, missing and inaccurate information can be mitigated by providing training programs to nurses and staff to properly educate them on filling out forms.

Marc Duey, MSc, MBA, president, ProMetrics

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