During an executive session sponsored by McKesson at Becker’s 12th Annual CEO + CFO Roundtable, health system leaders elaborated on these barriers and shared their unique, strategic approaches in delivering specialty pharmacy and infusion services. Two McKesson leaders, Prateek Bhatia, PhD, vice president and general manager for intrafusion, and Lindsey DeMarrais, PharmD, managing pharmacist consultant, facilitated the discussion.
Three key takeaways were:
- Access to specialty drugs is a top concern for health systems and patients alike.
Roundtable participants noted how the distribution of specialty drugs is sometimes limited to certain pharmacies, which can disrupt the care continuum for patients who need those drugs but do not live nearby. Some insurers also provide coverage for specialty drugs at lower co-pays, which may lead patients to switch insurers and, in the process, lose access to their usual healthcare provider.“Even very prominent health systems are having these challenges,” Dr. DeMarrais said.
- Potentially costly, hospital-based infusion centers are in payers’ crosshairs.
Hospitals are also facing pressures from payers to move infusion services from the potentially costly hospital setting to lower-cost outpatient settings. Although most hospitals and health systems may be reluctant to move their infusion services because of the associated potential financial impacts, those that are opening freestanding facilities in the community setting are finding that patients are thrilled to have them nearby. “Patients are excited to have these services locally instead of having to drive an hour away,” one roundtable participant said.
- Intentional partnerships with payers may help to address these dilemmas.
As healthcare continues to evolve and consolidate through mergers and acquisitions, specialty drug prices and infusion reimbursements will increasingly be in the hands of fewer but larger payers, several roundtable participants noted.To counter the negotiation power of payers, hospitals and independent infusion centers may consider partnering via joint ventures.
