What hospitals and health systems need to know to successfully operate a specialty pharmacy

The specialty pharmacy space is evolving quickly, and an increasing number of FDA-approved drugs are specialty drugs. In 2018, 34 percent of FDA-approved drugs were specialty drugs. And although only 2 percent of prescriptions filled in 2018 were specialty drugs, they made up 49 percent of the United States' total pharmaceutical spend. 

But the specialty pharmacy space operates very differently than retail, mail order or institutional pharmacies, and because of that, hospitals and health systems may be hesitant to enter the specialty pharmacy space. Leaders from Comprehensive Pharmacy Services' specialty pharmacy division, SPARx, discussed the benefits and challenges of operating a specialty pharmacy in a Sept. 28 webinar hosted by Becker's Hospital Review and sponsored by Comprehensive Pharmacy Services. 

The leaders were: 

  • Michael Heinrichs, PharmD, senior vice president of business development for SPARx
  • Eugene Queener, vice president and ambulatory pharmacy for SPARx

Five key takeaways from their discussion: 

  1. Specialty pharmacy has evolved drastically over the last decade. In 2010, only 16 percent of U.S. pharmaceutical spend comprised specialty drugs. In 2018, the number was 49 percent. The industry is now seeing a push to identify "specialty" as a class of trade from CMS, pharmacy benefit managers and manufacturers. Because the specialty pharmacy space changes so quickly, it's critical to set up the proper systems to make sure your facility can keep up.

  2. Specialty pharmacy should be addressed and implemented as an integral part of the existing health system's specialty pharmacy ecosystem, not as an independent, self-contained solution. Some specialty pharmacy solutions companies focus almost exclusively on developing a specialty pharmacy solution, but aren't expert across the entire spectrum of the specialty market ecosystem, which is a complex interplay of multiple existing components: infusion, retail, specialty providers, existing trade relations and payers.

  3. One of the biggest challenges in operating a specialty pharmacy is site-of-care shifts. Payers have discovered they are sometimes paying two or three times more for a drug depending on if it's administered in a hospital outpatient department versus a physician's office, and have implemented or plan to implement a site of care shift to save costs. Eighty-three percent of payers plan to implement site-of-care changes in the next 12 months, Mr. Queener said. A case study found one health system lost more than $7 million in net profits in one year from site-of-care changes from just two payers.

    Because of this, it's critical to develop a site-of-care strategy. Partnering with SPARx to develop a strategy can help reduce gaps in therapy, create opportunities for optimal patient outcomes and improve patient access to care.

  4. Design and build your specialty pharmacy with the future in mind. If your system is building a specialty pharmacy from scratch, it's critical to design it in a way that is prepared for the fast-paced environment. It's important to implement training systems to allow staff to understand the frequent changes that come with the specialty pharmacy environment, including legal and regulatory changes. For instance, 340B reimbursements change frequently, and the program itself has been challenged by drugmakers that believe the program causes duplicate discounts. If 340B were to disappear entirely, would your specialty pharmacy be able to operate on a 2 percent margin? Such questions are important to keep in mind when designing your pharmacy.

  5. SPARx's specialty pharmacy program guides hospitals and health systems along the process of designing or enhancing their specialty pharmacy operations. The program helps hospitals and health systems develop true strategic partnerships rather than strictly transactional ones to develop a long-term approach to accessing specialty drugs. It can also help hospitals and health systems with internal and external communication to gain buy-in, as well as navigate changes to legal and regulatory requirements.

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