Why leading health systems are choosing to build and operate their own specialty pharmacy: the patient and financial benefits

As specialty drugs become more common, the types and forms of these drugs are changing, and their costs are increasing.

For example, many new high-cost specialty drugs — even cancer drugs — can now be taken orally, in contrast to specialty drugs of the past that were administered via infusion in a hospital. In response, multiple stakeholders are racing to fill these prescriptions, including payers that are building out their own specialty pharmacies. These developments pose a significant strategic challenge to hospitals and health systems as they may be losing revenue from their infusion suites and seeing specialty prescriptions filled elsewhere.

At a workshop sponsored by CPS at the Becker's 10th Annual CEO + CFO Roundtable, Greg Wozniak, president and CEO of Denali Health, moderated a discussion with hospital and health system leaders whose organizations have created their own specialty pharmacies. They discussed the value of specialty pharmacy services, outcomes their organizations have achieved and their outlook for the future.

The panelists were:

  • Madeline Camejo, PharmD, chief pharmacy officer and VP pharmacy services, Baptist Health South Florida (Coral Gables)
  • Nancy Huntington, PharmD, director of pharmacy, Glens Falls (N.Y.) Hospital
  • Armando Llechu, chief officer of hospital-based care, Lee Health (Fort Myers, Fla.)

Four key takeaways were:

  1. Specialty pharmacy services can empower market growth amid market challenges. "Specialty pharmacy drives positive outcomes, reduces readmissions . . . and most importantly engages providers and patients," Mr. Wozniak said. Specialty pharmacy also has a positive financial impact for hospitals and health systems.

  1. Health systems that build their own specialty pharmacy see significant strategic value. "Specialty pharmacy becomes a very integral part of healthcare systems today to be able to keep their own patients, keep their own revenue and keep the quality," Ms. Camejo said.

    "Strategically for us, having a specialty pharmacy had a lot to do with creating continuity of care for our patients; having the ability to get them appropriate care and med management and helping keep our patients out of the hospital," Mr. Llechu said. "It was about, 'How do we best serve our patients in our community?'"

  1. Health systems that build their own specialty pharmacy can realize significant health and financial outcomes. Huntington said since her hospital created its own specialty pharmacy, the turnaround time for prior authorization of specialty oral chemo drugs is much faster. She also said patient safety has improved because embedded pharmacists with EMR access can monitor the patient's status and adjust dosages as necessary — which couldn't be done by a non-embedded specialty pharmacy.

    "We can look at how many of our patients are refilling their drugs," said Mr. Llechu, who has seen more patients adhering to their medications. His health system, Lee Health, has also seen satisfaction scores for both patients and physicians that "are off the charts." In addition, "We are reaping the benefits as a health system financially," he said. Two years post-establishment, the specialty pharmacy's financial return to the health system is about $1.5 million each month.

  1. Building an in-house specialty pharmacy requires the right partner. The panelists observed that specialty pharmacy is a beneficial service line but building one is complex. "The complexity of this business necessitates that you partner with somebody that understands and has the expertise in this particular domain," Ms. Huntington said.

As the landscape for specialty pharmacy changes, partners like CPS are helping a growing number of hospitals and health systems establish an in-house specialty pharmacy. By doing so, Mr. Llechu said, "You bring back a financial benefit to your organization on top of the social benefit to the patient population you serve."

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