SamaCare Series A
by Cheryl Cheng
Over the years I have sat down with executives from various pharmaceutical companies to discuss a range of innovation ideas. One of the consistent frustrations and biggest opportunities I hear of are the inefficiencies that providers, patients and pharma companies experience in trying to get patients on the right medications. Patients sometimes wait up to nine months for the drugs they need.
The pharmaceutical industry has gotten significantly more complex as drugs become more specific and sophisticated. It is no longer about getting a prescription filled at a local pharmacy. The specialty medication world has ballooned to over 400 specialty drugs and over $150B in revenues. Although only about 2% of the population is on a specialty Rx drug, these drugs constitute 51% of costs. Navigating this burgeoning world of specialty Rx is complicated but also filled with opportunity to deliver better treatments to patients.
Specialty Rx drugs are expensive.
SpecialtyRx medications are unlike traditional prescribed medications. Keytruda is perhaps the largest blockbuster among specialty medications and it costs on average $150K per patient. Given these price tags, specialty medications need prior authorization before they can be administered.
Workflow complexity
Being prescribed a Specialty Rx is not enough. Getting through prior authorization requires navigating a set of complex workflows put in place between payors and pharmaceutical companies, requiring providers to manage the process. It is estimated that between 30-46% of patients who are prescribed a specialty drug do not successfully get onboarded. One of the main drivers for this attrition is the complexity of prior authorization. For physicians, the prior authorization process is painful. They spend on average 15 hours a week on documentation and cumbersome workflow for prior authorization and benefits verification.
Lack of visibility and data insights
Within the specialty drug world, medication benefits are the most complex and costly. These are the medications administered in the doctors’ offices because they have to be infused or need additional medical attention while being administered. Unlike pharmacy filled prescriptions, there is less visibility into who is getting prescribed a medication, is the prescription getting authorized, and what are the blockers a physician may be experiencing in trying to get their patients onto a particular drug.
Vive is excited to back the team at Samacare, which is tackling the growing and complicated arena of specialty medications. As a single interface for physicians to manage all prior authorization (PA) and benefits verification (BV) across multiple drugs and indications, Samacare streamlines workflow for physicians and simplifies the PA and BV process.
Physicians no longer have to use brand specific PA portals with the Samacare product. Going beyond simplifying workflow and saving valuable time (both of which are already huge ROI), Samacare provides valuable data insights to pharmaceutical companies to help them improve their patient hubs and clinician experiences.
Today, Samacare works across oncology, retina, neurology and rheumatology special medications with many more on the horizon.
We are beyond excited to be partnering with the team at Samacare to positively impact accessibility and cost to getting specialty medications.