Health systems and hospitals see an opportunity to play in the specialty pharmacy space due to the economics, as well as improved patient outcomes and experience.
During a May 24 webinar hosted by Becker’s Hospital Review and sponsored by CPS SPARx, experts discussed how to successfully launch a specialty pharmacy. Panelists included:
- Keith Cook, division president
- Doug Massey, PharmD, senior vice president, specialty and ambulatory pharmacy services
- Susan Trieu, PharmD, vice president, trade relations
As Mr. Cook noted, “The top competitors for a health system or hospital specialty pharmacies are giants like CVS, Accredo, Optum and Walgreens. You need to keep this in mind as you build out your capabilities.”
Five insights:
- Infrastructure, licensing and provider relationships form the foundation of a successful specialty pharmacy. Many health systems bolt a specialty program onto their current retail operation, but this limits growth. “Specialty is trending toward being its own class of trade. Staying ahead of that change is key for growth,” Dr. Massey explained. “Retail and specialty programs must be licensed separately with the boards of pharmacy and have separate payer contracts.” Adequate facility space for future growth is essential, as is strong collaboration with legal, regulatory affairs, finance and IT. To cultivate provider relationships, health systems and hospitals should tailor marketing messages to providers’ unique needs.
- Accreditation is a differentiator between retail and specialty pharmacies. Payers and manufacturers require that specialty pharmacies be accredited. The four elements needed to obtain and maintain accreditation include a patient management program, quality, compliance and an operations infrastructure. Working with an experienced partner can reduce the time needed to achieve accreditation.
- Technology and data deliver patient satisfaction, as well as actionable insights. Interoperability among platforms like the EMR system, pharmacy management system, clinical management system, interactive voice response system and external apps and portals is crucial for efficiency and a smooth patient journey. Digital communication leads to better patient outcomes and satisfaction, while big data and predictive analytics provide organizations with better information for decision-making.
- A variety of factors affect pharmacy access to specialty drug products. Specialty manufacturers often limit distribution based on criteria that are specific to each drug and those criteria can be dynamic. “It’s important to know when to seek access to specialty products based on factors like patient needs in your community, speed to accreditation and reaccreditation, having the right technology and the ability to work across data aggregators,” Dr. Trieu said.
- Health system and hospital specialty pharmacies must determine which payers they want to work with. Large pharmacy benefit managers that own their own specialty pharmacies have a vested interest in keeping health systems and hospitals out of this space. It’s important to understand the contracts, including the reimbursement rates and fees, to determine whether your organization wants access to particular payers. Many employers like health system specialty pharmacies due to the integration with the delivery model, access to providers and the holistic approach to treating local patients.
Specialty pharmacy is complex and success comes from understanding the business, implementing these five best practices and measuring and monitoring operations to drive continuous improvement.
