Expert Highlights The Role of Patient Support Programs, AI in Improving Access to Specialty Medications

Josh Marsh, vice president and general manager of Cardinal Health Sonexus Access and Patient Services, discusses the role of patient support programs and artificial intelligence in improving patient access to specialty medications. He outlines 3 main challenges patients face in gaining access to specialty medications - education, access, and affordability. The potential of AI to help pharmacists by automating administrative tasks and allowing them to focus more on clinical consultation with patients is discussed.

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Q: What are some of the current challenges that patients can face in accessing medications, specifically for specialty medication which could be for more complex and costly conditions?

When I think challenges for patients gaining access to a specialty medication really comes down to 3 core areas. So education, access, and then affordability. So for education, I always remind patients, physicians, that this is much different than the doctor writing a prescription for amoxicillin and you take it into your local pharmacy, and 15 minutes later you walk out. There's a journey that the patients have to go through. It's early educating them on that journey, what actions they need to take, what their physician needs to do on their end, and then bringing that all together to get that patient through as quick as possible, and then the second one being access to the medication. So this, again, is not just the pharmacy pays for it, and you get it shipped to your house. There's benefit verifications that need to be completed, prior authorizations, potentially appeals or even step edits, meaning the patients are gonna have to try out their medication before they can get access to the therapy. So working through those access challenges with the patient. And the last one being affordability. Just because the insurance covers the medication doesn't mean that the patient can afford the medication. It could be $500-$1,000 a month for their copay. So making them aware of different resources that are available from the manufacturers or even applying for a patient assistance program as an underinsured patients. So those are really the three core challenges that we try to help patients overcome at Sonexus.
Q: What are common barriers that patients could face when seeking patient assistance programs for specialty medication?

I do want to differentiate between patient support programs and patient assistance programs, I think that's important. So patient support programs are reimbursement, affordability issues, patient education that we help patients navigate through. Patient assistance programs are programs that are sponsored by the pharma manufacturer that allow patients to receive free drug through a noncommercial pharmacy for those patients who are uninsured or underinsured. So I go back to the education piece on this one. A lot of times a patient if the insurance doesn't cover the medication, or if their copay is too high, they'll just abandon the prescription, and what we know is that that increases their symptoms and worsens their disease state, which then overburdens the overall health care ecosystem. So really educating the patients on the availability of these patient assistance programs is important, and then one of the barriers I would say to getting approved for a PAP program is that there is some legwork on the patient side and the physician side there's paperwork attestations that need be filled out, but thankfully, over the past couple years, a lot that's been digitized. So still has to be completed by the patient and the physician, but it's in a more kind of automated and technology forward focused.
Q: How can AI help pharmacists streamline workflow or help identify patients that qualify for patient assistance programs?

I'm really excited about what AI is doing, specifically for the pharmacist. I was a pharmacy technician for 5 or 6 years throughout my high school and college career, and I even know it now, right? We all know how overburdened the clinical pharmacist is and for AI, I think the most most optimistic area for AI in a pharmacist workflows, removing that administrative those non-clinical tasks from their workflow, automating that through the use of data and other sources so that the pharmacist can focus on the patient can focus on the clinical piece, to ensure that those patients can get access to therapy and they understand what to expect from a side effect perspective is this drug and make me feel better today, next month, and that's where we really need that clinical consultation between the pharmacist and the patient. So AI is really going to allow the pharmacist to free up that time to be more focused on that patient from a clinical perspective.
Q: How can pharmacists use AI solutions to better optimize patient access to medication and improve treatment outcomes?

So for pharmacists, what we're seeing with the use of AI is truly being able to differentiate every patient and their journey. So previously, maybe 100 patients come in all 100 patients go through the same workflow, we can now use artificial intelligence, different sources of data to truly build a unique patient journey for each patient. So some patients may need more manual touches from a pharmacist or outreach after they start medication. Other patients may be well versed, they've tried a specialty medication for in this class. So all they need is a text message to have some digital resources or a video to remind them of you know how to stay adhere to the medication, how to manage different side effects that they may see. So that's what we're seeing on the the pharmacist side when it comes to really injecting AI to look at every patient and uniquely versus lumping them all together, which we know helps patients get more access to therapy and stay on therapy longer, which is the goal.
Q: As AI becomes a bigger role in health care, how patient privacy and data security stay protected?

That's incredibly important. Right now, these AI models that you're seeing, they're all based on large volumes of data. So the first thing I always tell pharmacist is make sure that the patient is aware of what they're signing up for, if they're signing up for a patient support program or patient assistance program. The terms and conditions around the data piece is usually 1 paragraph, so the patients should be signing up for those programs, not the pharmacist so they understand how their data is going to be used. Then from a health care company perspective, for those of us using AI, we have to continue to get tighter when it comes to IT security controls security audits around the data that we're using to ensure that patient data is being protected at every every possible point.
Q: Is there anything else you would like to add?

One thing I'd love to add for the pharmacists, pharmacy technicians, everyone out there in that clinical setting is only on average, only about 10% of patients who get prescribed a specialty therapy are enrolled into a patient support program. So education, education, education is so important in this space. So when a patient comes in or sends in a prescription right for their specialty medication, and it rejects or there's a high cost for the medication, educate that patient on the availability of these programs, and always keep it pretty simple. They just google the name of the specialty drug plus patient support program, and they'll find a pharma manufacturer website that has all the resources available for them to engage digitally to enroll digitally or to call the hub at a 1-800 number to get more information about what resources are available to help them through their journey.