The Value of A Centralized Medication Access Team

Contributors: Angie Amado, PharmD, CSP, Senior Director at Visante Amy O’Kroley, CPhT, PACS, Specialty Pharmacy Service Manager at Visante

Centralized medication access (CMA) is revolutionizing the patient journey to specialty care. We consistently see the challenges that arise from the lack of medication access and believe that a centralized medication access team is the solution. It allows the clinical team to concentrate on what matters most: direct patient care. At the same time, it makes the process of obtaining specialty medications for patients much more straightforward.

The Challenges: What Happens When CMA Isn’t in the Picture?

CMA is a network where a pharmacy-driven medication access team manages all aspects of medication authorization and distribution. This ensures streamlined processes and improved access and affordability for patients.

Unfortunately, a CMA team is the missing piece in many struggling healthcare systems. To put it simply, medication access is absolutely necessary to achieve the best possible patient and healthcare outcomes.

• Increased Administrative Burden

One of the primary challenges for organizations lacking a CMA model is the increased administrative burden on providers and their staff. They are required to manage time-consuming tasks such as writing appeal letters and navigating insurance coverages, which detracts from their ability to focus on direct patient care. This administrative overload is not only a source of frustration but also a major contributor to provider and staff burnout.

• Inefficiencies in Operations

Without CMA, healthcare operations become less efficient. The absence of streamlined processes means that more time and effort are needed from healthcare providers and clinical staff to manage medication-related tasks. This hampers overall workflow and productivity.

Poor management of medication access often results in financial inefficiencies and reduced financial performance, which can further stress already limited healthcare resources.

• Delayed Treatment

Patients are directly affected by the lack of CMA through delays in receiving their medications. Slower authorization processes can impede access to necessary treatments.

Additionally, this often leads to missed opportunities for financial assistance, resulting in higher out-of-pocket costs for patients. This financial burden can be particularly challenging for patients with chronic conditions who require ongoing medication.

• Patient Stress and Confusion

The complexities of authorization and financial assistance processes without a centralized medication access team can also cause significant stress and confusion for patients. Navigating these complexities can be overwhelming, especially for those who are already dealing with serious health issues.

In fact, without streamlined access and comprehensive financial support, patients are less likely to adhere to their prescribed treatments. Lower medication adherence leads to poorer health outcomes and difficulties in managing chronic conditions.

• Logistical Challenges

Logistical challenges arise as patients may face hassles in obtaining specialty medications. They often have to rely on specialty mail-order pharmacies or navigate complex insurance directives, which can be cumbersome and inefficient for both patients and providers.

Integrating CMA: A Provider Support System

From writing appeal letters to  navigating insurance coverage, providers and their staff are often required to take on tasks that distract from patient care. A centralized medication model offers several benefits:

• Reduced Administrative Burden: Centralized services take over administrative tasks like handling prior authorizations, managing insurance claims, and coordinating with pharmacies, allowing providers to focus on direct patient care. Studies indicate that up to 75% of healthcare providers believe that centralized systems, like electronic health records (EHRs), enable them to deliver better patient care.

• Enhanced Operational Efficiency: Streamlined processes reduce the time and effort required from healthcare providers, improving overall workflow. Implementing CMA can lead to increased patient throughput and reduced medication errors.

• Improved Financial Performance: Better management of medication access leads to improved financial outcomes for healthcare facilities. Efficient patient access systems ensure accurate and timely capture of patient information, avoiding claim denials, underpayments, and delays in revenue collection.

• Better Clinical Outcomes: Hospitals with CMA have reported improvements in patient compliance with prescribed medications, resulting in better management of chronic diseases and reduced hospital readmissions.

Improving the Patient Experience

From skyrocketing medication prices to treatment delays, patients often face significant challenges with the medication access process. CMA offers several benefits for patients, including:

• Timely Medication Access: Centralized services expedite the authorization process, ensuring patients receive their medications faster. This leads to improved treatment outcomes as patients can start their therapies promptly.

• Financial Assistance: CMA connects patients with comprehensive financial support, including copay assistance and drug assistance programs. This reduces the financial burden on patients, making essential medications more affordable.

• Reduced Stress: By handling the complexities of authorization and financial assistance, CMA simplifies the process of receiving medications. Additionally, clear communication and streamlined procedures help reduce patient anxiety and confusion.

• Improved Health: With reduced financial and administrative barriers, patients are more likely to adhere to their prescribed treatments. This is crucial for achieving better health outcomes and managing chronic conditions effectively.

CMA: Your Comprehensive Solution

Centralized medication access is essential for the modern healthcare system; it solves many logistical challenges, boosts efficiency, and provides patients with peace of mind.