In the United States, some medications have a specialized fulfillment process which can be challenging for patients to navigate. Specifically, biologic medicines are dispensed by specialty pharmacies that deliver by mail-order only, ensuring the medication is appropriately stored and refrigerated throughout the delivery process.
As a patient, working with a remote specialty pharmacy can be less transparent than a neighborhood-based retail pharmacy. Examples of this include patients not knowing: which specialty pharmacy their insurance authorizes to deliver their medication, when it will be delivered, or how to easily reach the specialty pharmacy for updates or to make changes to the scheduled deliveries.
The goal of this challenge is to simplify the filling of biologic prescriptions for patients in order to improve access to medicines. The proposed solution should:
This solution should be implementable across all specialty pharmacies. The “challenge guidelines” and “additional context” pages describe in more detail the specific steps of the prescription journey that should be covered, along with context on biologic medicines and how the prescription system works currently in the US. Ultimately, by creating more transparency about biologic medicines and prescription status, we hope to help more patients receive the medications they need, when they need them.
This challenge is a call for ideas, and subsequent challenges may build out the technical, regulatory, and economic considerations in more detail for the winning solution.
Biologic treatments are protein-based drugs developed from living cells that are given by injections or intravenous (IV) infusions. They differ from small-molecule drugs (which typically appear as more familiar pills) in ways that affect their cost, production, and administration. The nature of their composition (fragile biological macromolecules and living cells) make biologics complex to transport and store, requiring special handling and refrigeration. As a result, payers exert greater control over handling of biologics, and biologics are usually delivered to patients through specialty pharmacies.
Specialty Pharmacies Context
Getting prescriptions, particularly for biologics, is currently not an easy process for patients. Due to the special characteristics of biologics mentioned above, patients must receive them from so-called specialty pharmacies who will deliver the prescription by mail.
The process of being prescribed, and ultimately receiving, a biologic medicine typically looks like the following:
When patients encounter the specialty pharmacy process for the first time, they may be more familiar with filling prescriptions for an oral or topical medicine from a retail pharmacy. Key differences in that experience include:
Some patients who do not understand these differences give up and do not ever receive their medicine. Those that do still have to handle weeks of uncertainty as the specialty pharmacy, healthcare practice, and insurance company correspond. And because this process requires significant support from healthcare practices, some doctors do not prescribe biologics and refer patients who need them to other physicians – adding more strain to the healthcare system. A transparent tool with on-demand status updates would help patients, as well as their providers, receive important medications in a timely and transparent manner.