The Effects of COVID-19 on Specialty Prescribing Habits

COVID-19 has impacted many industries including health care. These impacts were seen in specialty and HUB operations early on, but it has become increasingly apparent that COVID-19’s effects are long-lasting. Patient service providers and specialty pharmacies are facing challenges to facilitate prescribing of specialty medications, knowing that prescribers are looking for new and easy ways to refer their patients for products and services.

In the early phase of the pandemic, a drop in referral volume was evident due to shutdowns. As the country slowly reopened, most health care providers started to change their prescribing habits, including prescribing treatments without in-person consultations. Many physicians started looking for different methods to reach their patients through telemedicine and video chats. Depending on the disease state and physician specialty, many prescribers have adapted to remote work and prescribing from alternate locations.

Historically, specialty referrals have been largely manual. Prescriber offices kept a stack of prescription referral forms at the office that were filled out when a referral was needed. A patient signature was required for HIPAA authorization and other forms of consent. Prescribers would then sign the prescription section of the referral and fax it to the service provider who processed and triaged it to a specialty pharmacy for commercial processing. Although it was an old-fashioned, paper-based process, it mostly got the job done. However, COVID-19 has greatly disrupted this process and is leading the industry to think outside the box by offering alternative ways to refer patients for treatment.

The need for tools to streamline the referral process is becoming increasingly evident. Many prescribers do not have fax capabilities from remote environments and may not be able to electronically fax referrals either. This has led specialty manufacturers and service providers to push for different ways to accept referrals. Electronic prescribing, or e-prescribing, is the most obvious solution when it comes to sending a prescription to a specialty pharmacy. This is done via a verified e-signature through an electronic health record (EHR) that is integrated with platforms, such as SureScripts or eRx, which are valid ways to prescribe per pharmacy state board rules. The issue arises when this e-prescription is sent to the service provider in lieu of a referral. This is when e-prescribing is not as intuitive because the prescription can’t make it to the destination specialty pharmacy within a prescription transfer. In this case, a verbal pharmacist-to-pharmacist transfer or a fax transfer is required, which is a much less streamlined process than an automated triage that refers patients in large batches and includes images of prescription referral forms.

To combat this issue, many manufacturers, service providers, and vendors are starting to offer online tools to submit referrals virtually. A prescriber would fill out patient, prescriber, and program elements into an online form that then transmits the information to the service provider. However, the issue with these solutions is that they do not include a legal prescription for a referral. The prescriber would then have to e-prescribe in addition to online enrollment, which brings them back to the original issue. This may not be an issue in an exclusive distribution model where the entity receiving the referral and the e-prescription will end up dispensing the medication themselves. However, this is not a feasible solution in a limited distribution network with a service provider and multiple specialty pharmacies.

Other tools that are being developed include an eSignature to include the prescription with the online referral. The issue with this approach is that some pharmacies acting compliantly with their state board regulations may not accept these prescriptions. This leads to health care provider frustration. Pharmacies that end up receiving enrollments without legal prescriptions end up having to make an outreach to obtain a script, which can be cumbersome and may delay the initiation of therapy.

Another solution that manufacturers and service providers are exploring is a customized document upload tool. This would entail a prescriber filling out a prescription referral form in an editable PDF to then sign and upload to a secure portal for the service provider to receive. This image can then be triaged to a specialty pharmacy that will have everything it needs to process the referral, obtain commercial coverage, and initiate dispense. Alternatively, the prescriber can fill out a referral form manually, but filling out an editable PDF is preferred to ensure the referral is legible.

In conclusion, specialty providers are continuously looking for creative ways to facilitate patient referrals and prescribing of specialty medications in this new virtual age. Although COVID-19’s effects were initially viewed to be temporary, it is becoming more and more evident that the remote and virtual way of treating patients is becoming the new norm, and specialty providers have to adapt to provide the most streamlined solutions.

About the Author

Rami Chammas is the Director of Pharmacy Services at RareMed Solutions, the nation’s first rare disease-focused specialty pharmacy HUB. Rami oversees pharmacy operations and non-commercial pharmacy program services. Before taking on this role, Rami led implementation efforts at RareMed by successfully implementing numerous patient support programs across multiple diseases states. Rami began his journey through Specialty Pharmacy at PANTHERx Rare Pharmacy, where he was involved in projects across many departments including quality, product development, and strategic partnerships.

Rami received his Doctor of Pharmacy degree from the University of Pittsburgh School of Pharmacy and his Master of Pharmacy Business Administration (MPBA) from the University of Pittsburgh, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines.