Implementing Message-Based System Improves Patient Engagement, Adherence in Specialty Pharmacy


Because regular SMS messaging is not fully HIPAA-compliant, one solution may be to initiate contact via a text that links to an online platform.

Although finding and implementing a mobile platform for specialty pharmacy patients can seem daunting, the right system can increase patient engagement and adherence while allowing the pharmacy team to turn their attention to other issues.

During a session at the 2020 National Association of Specialty Pharmacy Annual Meeting and Expo, leaders from Fairview Pharmacy Services and Fairview Specialty Pharmacy discussed how they selected a mobile platform and what they learned from the process. Fairview Specialty Pharmacy has a single location with approximately 9000 patients in all 50 states, according to Melissa Nelson, PharmD, CSP, regional operations manager for Fairview Pharmacy Services.

Nelson said research has found significant patient support for message-based contact, with 83% of respondents indicating they would welcome text reminders about taking their medications, checking their blood pressure, or similar tasks. Similarly, 78% of patients said they would like to have a text conversation with a business. Perhaps most significantly, studies have found that text response rates are 209% higher than response rates from phone calls.

“[This] just really solidified that we were finding a solution that was really wanted by our patients,” said co-presenter Amanda Robinson, CPhT, access service manager for Fairview Specialty Pharmacy.

Robinson said prospective vendors should be customizable, integrated, compliant with both the Health Insurance Portability and Accountability Act (HIPAA) and the Telephone Consumer Protection Act, should be user-friendly, and have reporting capabilities. Nelson added that standard SMS messaging is typically not HIPAA-compliant and limits what information can be included in the message.

After weighing their options, Nelson said Fairview settled on Relay Network. Although it does not check all of the boxes on their list, Robinson and Nelson agreed that it has worked well. They rolled it out gradually, releasing refill reminders first in July 2019, followed by ad hoc messaging in August, 1-click ordering in November, and finally the implementation of a 2-way chat in July 2020.

Instead of solely communicating via text, the system initiates communication with an SMS message, including a link to their secure web space in which more personal information is provided. Robinson has also created more than 50 journeys, which she said are designed to provide a specific patient experience. Notably, Robinson said they are able to do a lot of work by themselves, without calling the vendor.

In just over a year, Robinson said 8885 patients have connected to the platform with just a 1.27% opt-out rate. Patients have used 71,580 journeys, with the most common ones including refill reminders, order scheduling, daily onboarding, and late refills. Phone calls per patient per month have decreased from 2 to 1.5, and although this rate seems small, Nelson said it’s significant when multiplied by the number of patients.

Perhaps most notably, patients who use the platform and click on the links in their texts have better adherence compared with patients who do not click through. Patients who were late to refill were also able to explain why, and Robinson said they found that patients who were 1 to 7 days late were typically still compliant. They may have filled their prescriptions early the preceding month or may have stopped taking them temporarily because of an infection or other medical reason. Regardless, Nelson said the messaging system clearly helps maintain adherence.

Finally, Nelson said they have had largely positive feedback from patients. In a survey, they noted that many patients described the platform as “convenient,” “easy,” and “user-friendly,” and the vast majority said they would recommend the platform. By continuing to expand the system’s capabilities and meet their patients’ needs, Nelson concluded that the software can be a great tool for pharmacy teams as well as their patients.


Nelson M and Robinson A. Utilizing Technology for Patient Communication in Specialty. Presented at: NASP Annual Meeting & Expo 2020; September 15, 2020; virtual.

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