Bringing Connectivity to the Specialty Pharmacy Workflow

The goal was to show how a connected specialty pharmacy workflow can have a positive impact on patient safety, drive better and more informed decision-making, and increase speed to therapy—to bring forward meaningful treatment at the right time to the end user—and on the final day of conference activity at AXS24, the 20th Asembia Summit, representatives from CVS Health and Surescripts did just that in the presentation, “How e-Prescribing, ePA, and EHR Connectivity Improves Specialty Pharmacy Workflow.”¹

Olga Korsunsky, RPh | Image Credit: CVS Health

“My objective has always been trying to figure out how we can take an incredibly complex process and simplify it for both doctors and patients dealing with these specialty conditions,” said Olga Korsunsky, RPh, executive director, Specialty Strategic Initiatives and Prescriber Innovation, CVS Health. “It's not easy, but it can be done.”

Her copresenter Ashley Fifield, strategic acount executive, Surescripts, concurred, noting, “What's amazing to me is how far we've come from where we were with paper and Meaningful Use being the impetus to get everybody using electronic systems, and where we are today in terms of the amount of information at our fingertips. However, there is still a lot of room for improvement.”

To frame how the prescribing workflow has a downstream impact on specialty pharmacy, Fifield detailed the numerous steps of what goes on at a provider’s office before a prescription ever arrives at the specialty pharmacy, using Surescripts’ system offerings as an example.

Ashley Fifield | Image Credit: Surescripts

Patient eligibility needs to be verified, and this involves determining the patient’s benefits coverage. There is a medication history review, which involves reviewing pharmacy benefit manager (PBM) claims and pharmacy fill data, which can start to help inform the prescription writing process. After the patient arrives for their appointment, they need to discuss with their care provider about their disease state and then check for appropriate formulary coverage, and based on medication history, determine if a new script is appropriate. At this point in the Surescripts workflow, there is a real-time benefits check, which returns cost information, potential step therapy intelligence, whether a prior authorization (PA) is involved, and potential therapeutic alternatives (generic, brand name, or biosimilar). In instances where a PA is required, Surescripts’ workflow allows health care providers to enter information in real time and transmit it direct to the PBM.

This electronic PA (ePA) process is meant to get the patient on therapy as quickly as possible, Fifield explained. It speeds the transmission of the prescription.

“It's really important to remember that we are talking about real time, and by real time I mean milliseconds; even seconds are meaningful when you have a 7-minute visit with a patient,” she said. “It's not a lot, so we need to make sure we are returning this information quickly.”

What does all of this mean to specialty pharmacy? How do these tools come to life for providers or pharmacies?

There is greater transparency with connected tools, Korsunsky emphasized. You can provide members with their medication history in the existing electronic health record (EHR) while at the same time identifying the member cost share, or finding lower-cost but comparable options, and you have that ability to let patients and their physicians know in real time if an ePA is possible or there are restrictions. In one example she provided, CVS was able to use these tools to find a lower-cost migraine medication alternative for a patient that saved the patient $175 per fill and the payer $694 per fill, or the equivalent of close to $10,000 in annual savings.

“You can see how these tools really come to life and if used properly, could be beneficial, really, for everyone here,” Korsunsky said.

Still, she continued, there is more that can be done to make this process more meaningful, and she explained additional ways in which CVS uses the information it gathers within the EHR. It can simplify new patient onboarding, the pharmacist can initiate PA on behalf of the patient (50% of the time) and verify dosing, and the latest lab results are contained within this record. This clinical interoperability can be used on a proactive basis, she noted, to fill in information gaps.

“Anything we need is basically at our fingertips,” she said, which also means no longer having to endure long waits on the phone with a doctor’s office as they gather the information you need.

The partnership between CVS Health and Surescripts has also seen the advent of a pilot program of direct clinical messaging that encompasses the ability to notify prescribers in advance of patient coverage changes and the potential need for new prescriptions.

“The type of interoperability that's being demonstrated here is a truly game-changing type of interoperability,” Fifield added.

The Trusted Exchange Framework and Common Agreement (TEFCA) is a big part of this electronic clinical interoperability, she continued, because it spells out how you can optimize and take advantage of the clinical information you gather, as well as protections of that data. It establishes governance, policy, and technical standards for the transfer of information between entities.²

“These qualified health information networks essentially have to be certified by a recognized coordinating entity to say that they meet all of the TEFCA common agreement standards,” Fifield explained, “that they can, in other words, act on your behalf to gather that clinical information and bring it to an end user, a specialty pharmacy, for example.”

Surescripts is in the process of getting TEFCA certified.

Another example of how CVS Health and Surescripts have partnered to optimize clinical interoperability through technology is with the use of RxChange embedded in the digital workflow of CVS Health pharmacies. This technology facilitates connection between prescribers and pharmacies by enabling prescribers to review and respond to pharmacy inquiries after submitting a prescription, and lets both parties (again) bypass time-wasting holds on the phone.

“It comes back as an eRx,” Korsunsky said, “so any of the automation that we might have around the electronic prescription and the safety of it is all preserved.”

The technology was developed by the National Council for Prescription Drug Programs, and it’s available at CVS specialty, mail order, and retail pharmacies. Of the 58% of prescribers who are enabled to receive notifications through RxChange, there is a 60% response rate in the specialty space and 25% of health care providers respond within 24 hours.^3,4

Through these proactive initiatives that strive for automation and interoperability, CVS Health and Surescripts have the common aim of simplifying the prescribing process to benefit patients dealing with complex specialty conditions and their health care providers. Their partnered success highlights how an interconnected health care ecosystem can become more efficient by putting patient care at the forefront.

References

1. Korsunsky O, Fifield A. How e-Prescribing, ePA, and EHR connectivity improves specialty pharmacy workflow. Presented at: AXS24; April 28-May 2, 2024; Las Vegas, NV. https://asembia2021.egnyte.com/fl/u6bmUePsTR#folder-link/AXS24%20Session%20Slides?p=6a4b5151-d07c-4181-89ce-54bb3a296747

2. Trusted Exchange Framework and Common Agreement (TEFCA). HealthIT.gov. Updated April 30, 2024. Accessed May 2, 2024. https://www.healthit.gov/topic/interoperability/policy/trusted-exchange-framework-and-common-agreement-tefca

3. Surescripts industry report, 2022.

4. CVS Specialty Operations proprietary data analytics, 2023.