The case for the health system specialty pharmacy coordinated care model

Year after year, the specialty pharmaceutical product category continues to grow and become more integral to patient care.

In fact, nearly 50 percent of all drugs will be in the specialty category by 20221. Payers reported that specialty drugs accounted for 32 percent of pharmacy costs2 and 22 percent of medical benefit costs3 in 2016. At the forefront of this trend are health system specialty pharmacies (HSSPs). Health systems that have included the specialty pharmacy as part of the patient care team set themselves apart as they provide coordinated care that will become essential as value based contracting becomes a reality. HSSPs rely on clinical coordination with providers, pharmacists and patients resulting in a more comprehensive approach to a patient. While health systems have much to gain from building specialty pharmacies, understanding the challenges and how to overcome them is paramount in the highly competitive specialty pharmacy market.

Benefits of Health System-Owned Specialty Pharmacy
In 2017, one in five health systems reported having specialty pharmacy capabilities4 and almost half of large hospitals (600+ beds) now operate a specialty pharmacy5. In-house specialty pharmacies enable health systems to accelerate a patient’s speed-to-therapy and improve quality of care through integrated clinical coordination. In addition, HSSPs can access a patient’s electronic health record (EHR) providing unique access to a patient’s information and enabling the health system specialty pharmacist to work directly with providers as an active member of the care team. Their close and synergistic relationship with the other care team members helps improve communication, therapy management and patient interventions. In addition, health system specialty pharmacists provide ongoing, high-touch patient care. They actively work with patients as they manage barriers to adherence, such as side-effects or financial pressures. This coordination results in a care ecosystem that focuses on the patient getting the right drug at the right time for optimal outcomes. And, these health systems often provide these services whether or not they are filling the drug, because it is the right thing to do.

Access Challenges & The Importance of Data
While health systems remain one of the fastest growing channels for specialty pharmacy, challenges exist with limited distribution networks and access to payer contracts. For example, many manufacturers have lean trade teams and those team members may not be able to keep up with all the emerging players. As a result, manufacturers will generally focus on pharmacy benefit manager-owned pharmacies and major independent specialty pharmacies. Similarly, payers typically include larger specialty pharmacies in their network, and they have limited time to vet individual, health system-owned specialty pharmacies. However, we are seeing more and more manufacturers want to work with health systems because of their high-touch model and access to specific patient populations.

Like health systems, manufacturers and payers want patients to access quality and cost-effective specialty care. All stakeholders are eager for data that can demonstrate key measures such as time to first fill, time on therapy, adherence and improved patient outcomes. HSSPs have a unique opportunity, as integrated members of the care team, to help capture and report comprehensive data that spans all care touchpoints – from start to finish of a patient’s entire episode. This data is likely attractive to both manufacturers and payers; it could not only serve as a critical key for health systems to gain access to networks but also help manufacturers and payers better understand the patient experience.

Creating Access
Health systems can work with their distribution partner to build a dialogue with manufacturers. With their long-standing relationships, distributors are uniquely positioned to serve as a respected advocate for expanding a health system’s access to innovative therapies. Together, they can collaborate on data strategies that will be attractive and helpful to manufacturers and payers. While working to gain increased access to therapies, health systems can also partner with an outside specialty pharmacy in the early stages of a pharmacy build-out. External partners can offer a full complement of services that can be leveraged initially and flexibly phased out as the health system’s capabilities increase.

HSSPs have an opportunity to show the true value of coordinated care. By aggregating and publishing their outcomes data and real-world evidence, along with patient experience measures, health systems can provide a convincing case to manufacturers and payers to expand access to their distribution and contracting networks. With access, HSSPs can provide a better patient experience – one that’s safer, simpler, well-coordinated and focused on the whole patient experience.

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