Specialty drugs are often hailed as miracles of modern medicine, lifesaving therapies for patients with cancer, rare diseases, autoimmune conditions, and more. But behind every prescription lies a hidden maze of bureaucracy. But before a patient can even begin treatment, they must navigate a fragmented system of prior authorizations, benefit checks, enrollment forms, and pharmacy coordination, mostly over the phone or by fax.

A patient might wait weeks just to hear back on insurance approval. Others give up entirely. And every missed refill or abandoned therapy represents lost time, revenue, and in some cases, worsening disease.

Why is access to these critical medications still so chaotic? And how can the system be re-engineered to serve patients, providers, and manufacturers better? Let’s get into the throes of specialty pharma operations to understand.

Why Patients Give Up Before the Drug Even Ships

Before a specialty medication can be dispensed, it almost always requires benefit verification and prior authorization (PA). These aren’t simple checks, they're complex, payer-specific processes that can take days or weeks. Each insurance plan demands different forms, documentation, and clinical criteria. And despite the push toward digital tools, nearly 50% of PAs are still submitted by phone or fax.

One physician described a typical case: four separate calls to four different reps, a 20-minute hold each time, and multiple follow-ups just to correct a missing field. It’s not uncommon for clinics to spend 30-45 minutes per submission, often chasing faxes or re-sending documents that were “never received.”

And the volume is staggering. The average physician’s office processes 39-41 prior authorizations per week, consuming nearly 13 hours of staff time, per physician. Many practices have hired full-time staff just to manage PAs. Others lean on nurses and assistants, who must spend their day on hold instead of with patients.

While the cost of these inefficiencies is enormous. $93 billion a year is spent on PA-related admin across insurers, physicians, and pharma companies; The real damage is to access: 40% of patients abandon therapy when a PA is required. And those who stay wait an average of 29 days to get their medication.

If the insurance roadblock takes this long to clear, what happens when the process hits the provider's side?

84% of Providers Say This Is Unsustainable. They’re Right

Once a doctor prescribes a specialty medication, they or their staff are responsible for enrolling the patient in the appropriate hub or specialty pharmacy. But with no standardization across programs, each drug can have its own forms, processes, and online portals. A GI clinic managing multiple biologics might juggle dozens of logins for different manufacturer hubs.

This leads to a cascade of errors. One missing signature or unchecked box can stall a case for days. Hubs fax back forms with red ink, or call the provider’s office repeatedly to collect additional info. In the meantime, the patient waits.

Some providers get so frustrated that they bypass hub services entirely. They try to manage enrollment, PA, and pharmacy coordination in-house, even if they lack the time or resources. Others simply avoid prescribing specialty meds unless absolutely necessary. In one survey, 84% of physicians called specialty med admin a high or extreme burden. And in smaller practices, nurses spend up to 10% of their workday handling insurance paperwork.

Even when hubs or pharma companies try to help, through field reps or reimbursement support, it often falls short. COVID reduced in-office visits by reps, and the gap in hands-on support is still felt. Meanwhile, physicians are left chasing updates, often with no real-time visibility into where the patient is in the process.

If providers are struggling to coordinate behind the scenes, what is it like for the patient on the other end of the phone?

You’ve Got One Shot to Reach Them. Then the Refill’s Gone.

For most patients prescribed a specialty drug, treatment is rarely as simple as picking up a prescription, it starts with multiple phone calls to a specialty pharmacy or hub, arranging delivery windows, responding to prior auth questions, or coordinating with insurers.

Everyone’s trying to help, but no one owns the full picture. One call turns into five. A form goes missing. A voicemail goes unanswered.
In a recent survey, 82% of patients said they spent at least an hour coordinating their specialty care. A third spent more than three hours.

Support teams do what they can. They make outbound calls for education, counseling, and refill reminders. But staffing is limited and patients get pushed into voicemail and IVR menus that offer no real answers. 92% of patients say they want 24/7 phone support for their specialty therapy but few programs offer it.

When calls go unanswered or coordination fails, therapy falters. Only 62% of prescriptions get filled, many abandoned after enrollment, during long periods of silence.

At $85,000 per patient per year, each lost fill hits hard, for both the manufacturer and the patient who never started care.

So if patients are falling through the cracks, providers are overwhelmed, and insurers are slowing things down, what can actually fix this?

The Power of One Voice, Talking to Thousands—24/7

What if getting a patient on therapy didn’t depend on faxes, voicemails, and manual follow-ups?

That’s the promise of Voice AI.

Unlike static IVR systems or one-size-fits-all chatbots, AI platforms like 100ms.ai act as intelligent agents. They make and take calls, collect data, and follow up, automatically.

They can:

• Call payers to check coverage, navigate IVR menus, and retrieve prior auth status
• Engage providers to collect signatures or missing labs, instantly
• Handle patient calls after hours, confirm deliveries, or schedule refills
• Triaging issues intelligently, routing the complex cases to humans and handling the rest themselves

Because AI doesn’t wait on hold or forget to follow up, it can shave off days or even weeks from time-to-therapy. One voice agent can handle hundreds of calls at once, meaning no one waits.

For patients, that means real-time answers to simple questions like “Has my refill shipped?” or “Did insurance approve it?” even at 11pm. For providers, less time on the phone. For manufacturers, fewer abandoned therapies and faster revenue realization.

Yes, it’s faster. But more importantly, it keeps more patients on therapy. And that’s what matters most.

Time-to-Therapy Down 30%: Smarter Calls, Faster Fills

Every hour saved in the access process directly increases speed to therapy, improves patient retention, and boosts manufacturer revenue. A few high-impact stats:

• Cutting time-to-therapy by 30% can translate to millions in quarterly revenue for blockbuster drugs
• AI-driven support can manage 10x the call volume of human agents at a fraction of the cost
• Better adherence = better outcomes, and a smoother experience for patients and providers alike

Plus, voice AI enables real-time data capture: call logs, response rates, time-to-resolution, all feeding into dashboards that make call centers smarter over time.

With privacy and compliance baked in, voice AI is the logical next step in modernizing how specialty therapies reach the people who need them.

Here’s how 100ms.ai Is Turning Every Missed Call Into a Moment of Care

In specialty pharma, every delay is a risk. Every call that goes unanswered, every form that goes unreturned, and every patient who doesn’t hear back fast enough can mean lost therapy, or worse.

Voice AI offloads the repetitive, robotic tasks and lets real people focus on the moments that matter most: the hard questions, the emotional conversations, the real care and specialty pharma can finally move at the speed that patients deserve.

Want to see how 100ms.ai can reduce your time-to-therapy by 30%? Watch a Demo or Talk to Our Team.