When Prescriptions Go Unfilled: The Critical Role of a Strong Medication Access Team

A Statistical Story of a Disjointed Patient Experience

Recent findings from the Specialty Pharmacy Continuum highlight the stark reality of unfilled specialty prescriptions. More than half of prescriptions for newly launched specialty medications never reach patients. Specifically, 52% of these new prescriptions are initially rejected by the payer, 13% are approved by a different payer, and 39% are rejected by all payers. This means that while 61% of original claims are ultimately approved and filled, 17% are later abandoned.

This leaves only 44% of prescriptions actually reaching the patient.

This challenge is even more pronounced when considering long-term adherence. Of those who start a novel specialty therapy, 48% refill at least once and only 29% remain on therapy after one year. The reasons behind these statistics are multifaceted, from insurance complexities to financial barriers. They underscore the urgent need for an integrated medication access team.

Additionally, the data highlights that this fragmented process diminishes the effectiveness of advanced therapies designed to address complex disease states. When patients are unable to access or continue their medication, the promise of better health outcomes is often lost.

Complexity of Care: Why Do So Many Specialty Prescriptions Go Unfilled?

Specialty medications—often high-cost, high-complexity treatments for disease states like cancer, autoimmune diseases, or rare disorders—require a unique support infrastructure to reach patients. Unlike traditional medications, they frequently demand:

• Benefit investigations
• Prior authorizations
• Financial support enrollment
• Education on usage and side effects

Without support at every step of this process, patients can face barriers that delay therapy, create confusion, or lead to abandonment of treatment entirely. These hurdles are a key reason why such a large proportion of specialty prescriptions never reach the patient’s hands.

Connecting the Care Continuum: The Indisputable Power of the Medication Access Team

A medication access team is staffed by experts who specialize in navigating insurance, payer policies, copay assistance, patient education, and pharmacy coordination. They have the power to make the difference between a prescription just written and a therapy actually received. This team:

• Ensures Coverage & Authorization. Prior authorizations and benefit investigations are complex and time consuming. Access team members proactively manage these, accelerating approval timelines and reducing administrative backlogs.’
• Connects Patients to Financial Assistance. Specialty therapies often come with significant out-of-pocket costs. Medication access teams guide patients through manufacturer assistance programs, foundations, and copay support options to make therapy affordable.
• Mends a Fragmented Care Continuum. These teams collaborate with providers, clinics, specialty pharmacies, and insurers to ensure that every stakeholder is aligned and the patient experiences a seamless therapeutic journey.

A Medication Access Team Turns Prescriptions into Real-World Health Outcomes

The journey from prescription to therapy goes beyond logistics and is a direct impact of clinical outcomes. When barriers delay or block access, disease progression may worsen, hospitalizations and complications may increase, and patient trust in the care process erodes. On the other hand, when medication access teams stretch beyond simple processing to provide advocacy and coordination, patient outcomes improve and the system functions more efficiently. Investing in a robust medication access team, helps ensure that:

• Care plans translate into action
• Patient adherence and satisfaction improve
• Health systems reduce avoidable downstream costs

Don’t Let Logistical Barriers Stand in the Way of Patient Care

As we know, the journey from prescription to therapy is far from simple. But a seamlessly integrated medication access team bridges gaps, advocates for patients, and drives efficiency across the healthcare system.

If your health system is ready to enhance medication access and improve patient care, Visante is here to help. Our team specializes in optimizing specialty pharmacy solutions, navigating complex insurance and financial hurdles, and ensuring that care plans translate into actionable results. Contact us today to learn how we can support your goals in delivering exceptional patient care!