E-Prescribing
Integrated workflows ease staff burden and satisfy regulatory mandates.
For decades, an Alzheimer’s diagnosis came with a difficult truth. The standard of care was medications that could offer symptomatic relief, but there was no way to cure the disease or even stop its progression.
That has changed. In 2023 and 2024, the FDA granted approval to drugs that demonstrated in large Phase 3 trials that disease progression can be meaningfully slowed.
But there’s a catch: Patients who qualify for these drugs often face administrative and financial barriers between the prescription and the first infusion. As June marks Alzheimer’s & Brain Awareness Month, we look at how access challenges—including prior authorization (PA)—threaten to leave clinical progress on the shelf.
The Specialty Medications Access Problem
The newer drugs showing promise cost between approximately $26,500 per year and $32,000 per year, with Medicare Part B patients typically being asked to pay 20% coinsurance after the deductible. This translates to $5,300 to $6,400 in annual out-of-pocket costs without supplemental coverage.
Unfortunately, data across the specialty medication landscape shows a direct link between out-of-pocket costs and patients walking away from their prescribed treatment:
- $0 to $50: Less than 10% abandonment according to a 2023 systematic review in the Journal of Managed Care & Specialty Pharmacy.
- Over $100: Abandonment rate jumps to 32% to 75%, depending on the medication, according to the 2023 review.
- Over $500: IQVIA Institute’s 2026 pharmacy claims data shows abandonment skyrockets to 60%.
For newly launched specialty drugs, the road to access and adherence can be even bumpier.
The Burden of Processing Prior Authorizations
Like most specialty medications, new drugs for Alzheimer’s require PA that can contribute to delays. The JPMC literature review found:
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For specialty drugs, peer-reviewed evidence shows that the PA process adds treatment delays of 3.6 to 31 days, with insurer processing times alone eating up 6.7 to 21 days.
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Patients fill only 14% of non-PA-approved prescriptions, compared to 78% of approved prescriptions.
The consequences of clunky processes extend beyond delays and access problems.
Many patients may abandon treatment altogether, as high as 78%, according to the 2024 AMA Prior Authorization Physician Survey of 1,000 practicing physicians. And 24% reported that extra time for prior authorization has led to a serious adverse event for a patient in their care.
Simplifying the PA Process
Electronic prior authorization (ePA) integrates the request directly into the existing clinical workflow. End-to-end automation speeds access to care by pulling patient data, clinical documentation, and payer-specific requirements directly from the EHR.
To learn more about how access delays and cost barriers impact patient care and the must-have tools that help them get on therapy, check out Stopping the Domino Effect of Specialty Medication Barriers.
