Q&A: Automated system is 'an essential tool' for processing specialty prescription drugs

Key takeaways:

• Refill Express is an automated system that is used to schedule and ship specialty medications.
• Health care workers saw a 50% reduction in administrative time spent on the refill process.

An automated system may alleviate the administrative burden that comes with specialty prescriptions while improving fill rates, according to experts.

In the spring of 2020, the University of Pennsylvania Health System pharmacy was processing 7,000 specialty prescriptions each month by phone for patients who have conditions like autoimmune diseases, cancer and cystic fibrosis, according to the university’s website. The process often required three call attempts, with staff members usually reaching patients by day 4.

A team at the University of Pennsylvania Health System partnered with Way to Health to create Refill Express, an automated system they hoped would alleviate administrative burden and save money. After piloting the system, the team found that it reached most patients within 24 hours and increased average prescription fill rates from 84% to 96%.

Healio spoke with Mohan Balachandran, chief operating officer of Way to Health, and Danielle Burkhart, PharmD, the residency program director for the PGY2 Ambulatory Care Pharmacy Residency at the Hospital of the University of Pennsylvania, to discuss Refill Express, benefits and drawbacks to the system and more.

Healio: Why did you decide to try out an automated system for processing specialty prescription orders?

Balachandran: These conversations started pre-pandemic. Hiring qualified people is always a challenge. Retaining them is an even larger challenge. The goal of the project was to try and automate as much of the grunt work as possible while still ensuring patient satisfaction and safety. The secondary aspect was one of patient convenience; no one likes a call at an awkward time. The intent here was to try and make the conversation asynchronous; patients can respond whenever it is convenient for them.

Burkhart: We wanted to modernize our outreach to patients while reducing the administrative burden on staff. Most patients have smartphones and would prefer to communicate in a manner that is convenient and least disruptive to their day. The backdrop of this project was the pandemic in which most health systems had difficulty retaining and hiring staff, so this provided an opportunity for us to continue to expand this vitally important program while facing staffing challenges.

Healio: Can you describe Refill Express? How does it work?

Balachandran: Refill Express is focused on specialty medications. These are lifesaving medications that require close monitoring and can be high cost. We therefore tend to keep a close eye on the refill cadence. Once we know that a medication or a set of medications are due for a refill, we automatically reach out to the patient and then verify a few details — how many doses they have left, their current mailing address, a preferred shipping method, delivery date etc. — and based on that, automatically schedule and ship the meds they need. In addition, we evaluate clinical matters during these text exchanges such as potential side effects, which are then triaged to the clinical team.

Healio: What were your experiences with Refill Express? How did this collaboration change the way you were processing specialty prescriptions?

Burkhart: Refill Express has transformed the way we conduct specialty pharmacy operations. The Refill Express program has cut the administrative time for staff in half compared to our traditional telephonic communication. The program was quickly scaled up to all of the specialty services lines including oncology, neurology, autoimmune, infectious diseases, cardiology and pulmonology. This process is now ingrained in the Hospital of the University of Pennsylvania specialty pharmacy procedures and is an essential tool for both staff and patients.

Healio: What were some of the benefits to using the automated system? Did it save time?

Burkhart: There are many benefits to the system, including a 50% reduction of administrative time spent with the refill process. Additionally, we have seen a very positive impact on patients. We conduct patient surveys utilizing Net Promotor Score (NPS) and found that we consistently have NPS scores indicating promotion of services, with a current cumulative score of 87.

Healio: Were there any downsides?

Balachandran: The program may not be for everyone because of the phone and texting requirements, so our original system is still needed for those patients.

Healio: Do you think other physicians would benefit from using a system like Refill Express for specialty prescription processing? What factors should they consider when deciding to make this change?

Balachandran: We think so. Groups should be mindful of privacy regulations, patient consent to be allowed to text with them and the volume of text messages being sent. Also, a system that complements existing operations to allow for a smooth implementation and sustainability for this type of program. We spent a lot of time on each of those.

Healio: Is there anything else you’d like to add?

Burkhart: It is not often that a complex idea transforms into a reality. The success of this program is a testament to the incredible team on this project that worked closely together to create something that has exceeded expectations and shown longevity, as the program reaches its 3-year anniversary in July.

Reference:

• Refill Express. https://healthcareinnovation.upenn.edu/refill-express. Accessed April 7, 2023.