How systems can develop an effective specialty pharmacy strategy

An increasing number of FDA-approved drugs are specialty drugs and experts predict that they will soon account for 44 percent of industrywide revenue — a fivefold increase from 2010 to 2020. For health systems with outpatient pharmacy services, developing an effective specialty pharmacy strategy can increase medication adherence, improve the patient experience and capture specialty prescription revenue. 

Michael D. Brown, vice president of managed services at Cardinal Health, and Larry Gray, chief executive officer of Seminole (Texas) Hospital District, recently discussed how to develop an effective specialty pharmacy strategy during an April 29 webinar hosted by Becker's Hospital Review and sponsored by Cardinal Health. 

Three key takeaways from their discussion: 

  1. Accreditation is not the only option: Building a specialty pharmacy is not a one-size-fits-all model, Mr. Brown said, and having an accredited specialty pharmacy is just one of several options for health systems to consider. Cardinal Health helps health systems determine the optimal model for their individual needs by analyzing three specialty pharmacy drivers: patient mix, payer mix and local employers.

    In addition, understanding each organization's unique population health, disease states and most prescribed drugs is fundamental to evaluating different pharmacy models. Lastly, your analysis should include high-cost, high-volume employee prescriptions.

    "We really dug deep into what we were spending now, what that distribution was and getting a handle on those high-cost drugs," Mr. Gray said. "It really paid off in that we could look at patterns of spending and opportunities for cost savings."

  2. Your pharmacy approach should be aligned with your health system's strategy: An important step for Seminole was to understand the community's healthcare needs. The health system completed an in-depth community needs assessment that analyzed the population demographics and healthcare needs. It revealed that access and affordability are priority community health concerns, and an outpatient pharmacy was a solution that could address those concerns.

    "Getting the right data to measure our results was key in this analysis," Mr. Gray said.

    "Everyone is seeing more complex patients," said Mr. Gray. "It puts you in a situation where you want to understand that data and have a strategy going forward." The next steps for Seminole were to reevaluate its health insurance agreements and to introduce and expand pharmacy services.

  3. Assess your PBM strategy: After initial first steps, Cardinal Health recommends establishing PBM partnerships to make specialty drug spend more viable. "Just because you have an accredited specialty pharmacy, it doesn’t get you automatic access to these [specialty] drugs," said Mr. Brown.

    There are two focal points for assessing your PBM strategy, said Mr. Gray, "One coming from your third-party administrator or in-house claims group, and then looking at what you’re getting from the payers, as well, in terms of their analysis. All of that has to be analyzed together to get a big picture."

    Finally, Mr. Brown noted that the very first step is to strengthen your existing retail pharmacy operations. "Start with strengthening your existing retail strategy and get good at that," Mr. Brown said. "It may sound cliché, but 'land and expand' — you can add new services into your retail strategy and it will continue to grow."

    This overall approach has driven results for Seminole, Mr. Gray added, citing a 24% increase in patient volume to the health system's outpatient pharmacy, as well as significant cost reductions. To see what other tips were shared during the webinar, listen to the webinar replay here.

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