Opportunity

Specialty medications drive revenue for health systems, and adherence is critical for patients to achieve successful outcomes.

In the spring of 2020, Penn Pharmacy was processing 7,000 specialty prescriptions per month by phone for patients with conditions such as cancer, cystic fibrosis, and autoimmune diseases. Three call attempts were being made, with technicians typically reaching patients on day four.

With this highly manual process, Penn Pharmacy averaged 84 percent fill rates across patients with specialty prescriptions. However, there was no capacity to grow the program as staff were completely tied up with existing responsibilities.

Intervention 

In June 2020, the Penn Pharmacy team partnered with Way to Health to explore ways to enhance workflow efficiency for specialty prescriptions while maintaining fill rates.

The product of this collaboration is Refill Express, an automated system that guides patients through an easy-to-navigate text conversation to process specialty prescription orders in a matter of minutes. In addition to processing orders, verifying shipping and co-pay information, and confirming the delivery date of medications, the system is also equipped to assess medication adherence and capture side effects reported by patients.

When orders are processed via Refill Express, information is pushed directly into Penn Medicine’s electronic health record so that technicians can begin filling orders immediately.

Impact 

Refill Express reaches 80 percent of patients within 24 hours with no technician effort required. The program has cut administrative time for staff in half compared to traditional telephonic communications. 

The increased efficiency of the automated system reduces the occurrence of missed doses due to lapses in access to medication, decreases expedited shipping costs for the health system, ensures patient satisfaction by maintaining an average net promoter score of 87, and has enabled the rapid rollout of new specialty prescriptions such as GLP-1 medications.

During the initial pilot, average fill rates for specialty prescriptions rose from 84 to 96 percent. Since then, the program has been scaled to seven Penn pharmacies with over 200 specialty pharmacy medications, leading to increased revenue for Penn Medicine and increasing the capacity for Penn Pharmacy to serve more patients – nearly 6,000 as of 2023 – in need of specialty prescriptions.

With the ability to capture adherence, Refill Express has been used to identify medication lapses affecting vulnerable patient populations, such as those who are uninsured or underinsured, so that they can be connected with case managers, financial aid advocates, and provisional medications.

Given the successes of Refill Express, the platform's functionality is now being used as a model for a new pilot directed at the non-specialty refill order process and may be applied to monitor medication adherence in the kidney transplant program.