Becoming Part of the Solution
January 23, 2025
How patient support programs are helping to drive healthcare system efficiencies
Patient support programs (PSPs) lie at the heart of specialty therapeutics, helping patients move through the steps required to initiate and continue treatment. By expediting drug access, patient training, and other support services, PSPs address gaps in the Canadian healthcare system. Innovations in PSP design and scope also are enabling these programs to collect real-world data and generate real-world evidence to inform healthcare decision making, and create system-wide efficiencies in healthcare administration.
Creating efficiencies ranks as an especially high priority for a healthcare system under stress from many directions, including the volume of paperwork that healthcare providers (HCPs) have to manage. In a survey by the Canadian Medical Association (CMA), three-quarters of physicians reported their administrative workload gets in the way of caring for their patients; for a majority of respondents, administrative burden also impacted job satisfaction and mental health.1 Respondents estimated that more than a third of administrative tasks could be eliminated altogether or re-allocated to another member of the clinic team.
With these challenges in mind, we’re devoting this issue to exploring how Canadian PSPs are helping to drive efficiencies in the healthcare system. What’s being done to improve PSP processes and set standards, so that all healthcare stakeholders can make the best use of their valuable time? And how can these improvements further support patient care?
SETTING NEW STANDARDS FOR PSP PROCESSES
While PSPs inevitably require some administration, a focus on efficiency can considerably reduce the burden and give valuable time back to clinicians and patients. The initiatives described below are doing just that.
A multi-manufacturer PSP model
It’s common for patients with a chronic condition to move through several different medications – and likely several different PSPs – throughout their treatment journey. In one survey by the Canadian Arthritis Patient Alliance (CAPA), 90% of respondents had enrolled in multiple PSPs, and many found it challenging and stressful to move from one PSP to another when changing medications.2
“[Changing PSPs] was bumpy. I had to start over with the financial assistance, and the contacts changed without being informed of who I was to deal with from now on”
Patient respondent in a CAPA survey3
To solve this problem, several pharmaceutical companies are collaborating on a new model that funnels all PSPs in a given therapeutic area through a single point of contact, irrespective of the manufacturer. A centralized approach allows patients to have the same PSP case manager throughout their journey, removing the effort and stress of enrolling in a new PSP and dealing with a new case manager for each new medication. Called ONE Team, the program is currently being piloted in ophthalmology clinics.
This approach reduces the administrative burden on health providers, leaving more time for clinical care. “Every minute saved means another minute for patient care. In a high-patient-volume environment like an ophthalmology clinic, even a 30-second time savings per patient quickly adds up,” says Taflyn Hornibrook, Chief Executive Officer of Sentrex, the PSP provider at the centre of this initiative. “For clinics treating over 100 patients daily, these efficiencies enable them to see up to 4 additional patients each day, helping bring timely care to more people in need.”
“Every minute saved means another minute dedicated to patient care.”
Taflyn Hornibrook
Chief Executive Officer, Sentrex
Reforming the enrolment form
Consider the paperwork resulting from more than 400 PSPs in Canada,4 each with its own enrolment form. While the forms have a lot of basic information in common – patient contact details, patient consent, and prescription information, for example – the lack of standardization in format and content increases the burden of filling them out and can hamper the consistency of information reporting.5
Standardizing PSP enrolment forms could thus create efficiencies for health stakeholders and for the healthcare system as a whole – a topic under investigation by a team from the University of Toronto, along with PSP researchers and industry experts. In a recently presented study, investigators collected over 100 forms and identified a huge variability in the formats and types of information gathered across PSP forms. Within the “patient information” section, for instance, some forms lacked information about key patient identifiers, like their health card number.5 The investigators saw “an opportunity to standardize parts of the form, while still allowing for flexibility to account for differences that exist across therapeutic areas, drugs, and PSPs.” To this end, they are developing best practices for PSP enrolment forms.5 A file to watch in 2025.
Digitizing prior authorization: paving the way for PSP forms?
In private drug plans, the prior authorization (PA) form – an additional step with some higher-cost drugs – helps ensure a good fit between product and patient. The payers set the criteria for coverage, and patients and their HCPs submit the required medical evidence. Just like PSP enrolment forms, these PA forms have not been standardized and they often don’t integrate easily with electronic medical records (EMRs).6 As the number of medications requiring PA continues to increase6, the burden on HCPs and patients increases apace.3 Thankfully, two new initiatives are harnessing technology to lighten the load.
The Canadian Medical Association, MD Financial Management Inc. and Scotiabank, has recently announced the Health Care Unburdened Grant program, which offers a total of $10 million to help companies “implement innovative ideas to help physicians reclaim lost time and improve patient care.”7 One of their first grants – close to $1 million – will support the creation of the first electronic standards for PA forms in Canada, to be developed by GreenShield Canada in collaboration with technology solutions provider OkRx and Dr. Sonja Gill, an Ontario-based expert in rheumatology and internal medicine. Initially the program will focus on rheumatology, with the goal of eventually expanding to all medical conditions and private insurers.6,8 If all goes as planned, this digital standard will expedite access to treatment and thereby improve patient outcomes.
Also of note in the PA space is the Prior Authorization Framework and Accreditation Program (PAFA), a non-profit organization that has created a set of standards for more efficient handling of PA requests. Canadian private and public payers can now receive PAFA’s seal of approval, based on successfully achieving certain administrative efficiencies and/or implementing electronic PA systems. PAFA is also developing additional standards to motivate its accredited members to innovate in such areas as automated PA adjudication and accelerated approval processes.9 Perhaps such innovations can inspire parallel changes in PSP forms.
Using technology to rethink basic processes
Software company Auxita has been working on a treatment-agnostic digital PSP platform that uses artificial intelligence (AI) to automate repetitive and inefficient parts of the PSP enrolment process. “We’re trying to help everyone get away from the confines of thinking about ‘the enrolment form’ for PSPs,” says Patrick Morin, EVP of Growth and Operations for Auxita. “A form is just information, and the format isn’t central to its function.” The system handles all aspects of a patient’s PSP enrolment digitally, with no need to fax or mail out hard-copy forms. In case faxes or handwritten forms do get involved – as still happens in healthcare – the system can convert them to a standardized digital format. What’s more, Auxita’s platform dovetails with hospitals’ EMR systems and with the customer relationship management (CRM) systems used within PSPs.10
In a similar bid for efficiency, Canada Health Infoway has developed a made-for-Canada HL7 Fast Healthcare Interoperability Resources (FHIR) framework, which delineates how to set up health record systems to facilitate information sharing across different providers, patients, and PSPs.11 The FHIR standard is already being used in many EMR systems in the US, as well as by major tech vendors including Apple and Microsoft. With its implementation in Canada, PSPs can audit their own data collection and sharing practices against the standard, and tweak their processes as needed.11
These efforts to streamline PSP processes and create PSP standards bode well for the future. More initiatives of this type will reduce the burden of PSP still further, giving valuable time back to clinicians and patients. We’re on the right track – let’s keep going.
References
1. Canadian Medical Association. Our focus: Administrative burden. https://www.cma.ca/our-focus/administrative-burden.
2. Canadian Arthritis Patient Alliance. Patient Support Programs Survey Results. https://arthritispatient.ca/en/patient-support-programs-survey-results/
3. Canadian Arthritis Patient Alliance. Webinar on Patient Support Programs Survey Results. https://www.youtube.com/watch?v=tSwDH_DUYS4
4. Waldron & Associates original research.
5. Mitha A, et al. Canadian Patient Support Program Enrolment Form Standardization. Poster at the Canadian Association for Population Therapeutics Conference, October 21, 2024. Toronto, Canada. https://bit.ly/3BtnZDL
6. Canadian Medical Association. GreenShield. https://www.cma.ca/our-focus/administrative-burden/health-care-unburdened-grant/greenshield
7. Canadian Medical Association. The Health Care Unburdened Grant Program. https://www.cma.ca/our-focus/administrative-burden/health-care-unburdened-grant.
8. Simplify Prior Authorization. Significant Grant Awarded for Development of Electronic Prior Authorization in Canada. Available at: https://www.simplifypriorauth.ca/2024/06/23/significant-grant-awarded-for-development-of-electronic-prior-authorization-in-canada/
9. Prior Authorization Framework and Accreditation (PAFA). Program Guide. https://priorauthframework.ca/wp-content/uploads/2024/09/PAFA_Program_Guide.pdf
10. Canadian Healthcare Technology. Transformation of forms to a digital process means better flow. https://www.canhealth.com/2024/09/30/transformation-of-forms-to-a-digital-process-means-better-flow/
11. Canada Health Infoway. H7 FHIR. https://infocentral.infoway-inforoute.ca/en/standards/canadian/fhir