Solving the Prescription Drug Shortage: Q&A with Peter Ax

Peter Ax
Founder and CEO
UpScriptHealth

UpScriptHealth is a digital health company that focuses on filling prescriptions online through telehealth sessions. The company’s founder and CEO Peter Ax spoke with Pharmaceutical Executive about the current issues the industry is facing with prescription drug shortages and how recent decisions from the DEA may help solve these issues.

Pharmaceutical Executive: What’s causing the prescription drug shortages, and how can the industry solve its pipeline issues?
Peter Ax: One of the macro factors impacting drug shortages is the supply chain constraints that are lingering from the pandemic when facilities were shut down and labor was in short supply. In many jurisdictions, labor challenges continue. Another factor is that the demand for various therapies has risen due to various demographic factors such as an aging population. Currently, 70% of Americans are taking prescription medications regularly. At the same time, recent medical advancements such as GLP-1s are drastically driving demand for all weight loss medications.

To solve drug shortages, there must be a significant investment to increase capacity and collaboration among various stakeholders to provide better transparency and insight. In addition, the pharma industry must prioritize forecasting capabilities, and I believe AI will help quite a bit in this area.

The UpScript digital platform ensures pharma companies are more informed about supply and demand concerns. Through our ecosystem, patients are connected with specialized telehealth providers to discuss the disease states they are seeking treatment for and also with the pharma companies that supply the medications.

This efficient care approach provides real-time visibility into supply issues and enables us to address concerns quickly. For example, people often assume their prescriptions will be filled at the pharmacy when they drop them off. Yet, there is actually a real probability the order will not be completed, or the medication will be prohibitively costly, or that the prior authorization is not executed correctly and health insurance will not cover it.

UpScript’s fully integrated solution can instantly identify supply constraints that would impact the prescribing decision. Thus, we can plan for demand, and alleviate so supply issues. Since we process all prior authorizations promptly, we are more aware of actual demand.

PE: Why are prior authorizations under scrutiny at this moment?
Ax: Prior authorizations have always been controversial, but recent healthcare worker shortages may have exacerbated the pain points for healthcare providers. While PBMs will call them "utilization management" and speak to the savings they create for the overall system by limiting the use of expensive, branded medications, many physicians view them as interfering with their patient care.

Healthcare providers often complain that prior authorizations dis-intermediate the physician-patient relationship and increase the cost of healthcare by causing a larger administrative burden for their practices. Larger medical practices may require three or four staff members to be dedicated solely to processing prior authorizations for patients. This is a big challenge when they are already understaffed due to labor shortages.

PE: How would the DEA loosening Telehealth rules for controlled substances impact the industry?
Ax: Prescription medications that are classified as controlled substances are an integral part of care programs for many Americans of all ages who need them for ADHD and other conditions. In reaction to the opioid crisis, the DEA has placed strict controls on such medications. In addition, access to care remains challenging because of a shortage of practitioners. Access is also an issue for those living in rural areas or “care deserts" that do not have adequate healthcare facilities to meet patients’ needs. Nearly 84 million Americans live in areas with a shortage of primary care health professionals. Patients wait far too long for care–even in the largest U.S. cities, it takes an average of 26 days to get an appointment with a new doctor. Loosening telemedicine rules for controlled substances would improve access to care for many Americans, as they would be able to talk to a doctor within a matter of hours without leaving their homes. The DEA could treat highly addictive medications like opioids differently than controlled medications that aren’t highly addictive.

PE: What trends are you seeing in the online prescription space?
Ax: It has taken far too long for healthcare to adjust to the digital world; however, today we are seeing clear and decisive demand for digital solutions to address current problems with care delivery. Specifically, UpScript partners with pharmaceutical and medical technology companies to improve patient access by providing telemedicine visits for patients seeking innovative therapies, from prescription medications to medical devices to diagnostic tests. We are seeing extraordinary demand from pharma companies that want to remove pain points and red tape for patients to improve care. We are also seeing significant demand from consumers who want to access various therapies quickly, conveniently, and affordably. During the peak pandemic era, people saw how many of their medical needs could be solved remotely through telehealth and how convenient it was, and they want that to continue.

While direct-to-consumer telemedicine initially began with lifestyle drugs for things like hair loss, we are now using it for more complex, life-saving treatments. Our team wrote the first compliant, online prescription in the U.S. way back in 2002, so we have had a front-row seat to this evolution. Now, UpScript helps patients access everything from EsoGuard tests that detect signs of esophageal cancer to medical devices and treatments for serious conditions like diabetes and sickle cell disease.