Breaking Silos: How Health Systems and Manufacturers Can Drive Progress Together

Optimizing patient care while ensuring your institution adjusts to the complexities of new therapy regimens and the ever-changing specialty pharmacy industry requires continuous navigation for both health systems and pharmaceutical manufacturers. Though health systems and manufacturers often work in tandem within the pharmacy industry, navigating the specialty pharmacy field has traditionally been managed in silos, whereby each group is independently developing new strategies to positively impact patient care.

Image credit: Have a nice day | stock.adobe.com

The utilization of limited distribution networks (LDNs)—or restricting the number of pharmacies that can dispense the medication—is an example of how manufacturers are shifting their strategy; however, these networks often leave health systems’ clinical staff with newfound administrative strains due to additional requirements needed to resolve medication access barriers.¹

Independently, health systems with an integrated delivery network (IDN) have dedicated resources to ensure patients are able to access, afford, and adhere to prescribed specialty medications, but IDNs need to be included in LDNs to access a manufacturer’s product and utilize these dedicated resources to deliver optimal patient care.

To help bridge this gap across the industry, a willing and highly capable IDN can build collaborative partnerships that help manufacturers develop and implement distribution strategies by which IDN’s can utilize their unique advantages. By sharing the positive impact of services for patients and providers and valuable insights into the patient and provider journeys, IDNs and manufacturers can work together to resolve gaps in care for patients and minimizes the difficulties providers often face throughout the patient journey.²

Takeda Oncology and Vanderbilt Specialty Pharmacy with Vanderbilt Health Systems (VSP) are working to bridge gaps in patient care by breaking down the silos and working together to identify, prevent, and mitigate barriers to treatment and optimize patient outcomes. Takeda Oncology recognized the depth of direct patient care an IDN provides and was willing to partner to collaboratively optimize the treatment journey and ensure their new medication launch successfully considered the entire medication access process.

Specifically, Takeda Oncology reached out to VSP to work through a new medication launch plan with the goal that deliverables from this pre-launch collaboration would streamline the launch and improve the provider and patient experience. By partnering with VSP, Takeda Oncology gains valuable insight into the patient and provider journey, directly from the health care team, from which they can tailor their strategy to respond to real-world use cases of their systems for patients to ultimately access their medication. In turn, this partnership grants VSP the ability to best prepare for the complex specialty medication launch and ensure both organizations have collectively addressed all foreseen barriers.

Initial conversations between Takeda Oncology and VSP’s Market Access and Trade Relations teams centered on how to be better partners on future drug launches. Takeda Oncology had spent the previous year researching and revising their style of account management and ways of engaging with pharmacies that are integrated with healthcare organizations and identified the upcoming launch of fruquintinib, a new oral therapy for the treatment of metastatic colorectal cancer (mCRC) pending FDA approval, as the therapy ideally timed to test the new process.

VSP expressed their willingness to partner with Takeda Oncology on this launch and, using outcomes research and capabilities information, demonstrated the value a capable IDN could bring to a manufacturer’s distribution strategy, specifically with regards to high touch, complex specialty medications. Both parties expressed a willingness to think outside of the box and an openness to collaboratively pursue an innovative opportunity, and ultimately a partnership for Takeda Oncology’s upcoming medication launch was established.

A collaborative whiteboarding session was scheduled for 4 months prior to the anticipated launch that would include a diverse set of team members from both Takeda Oncology and VSP. Preparations for the whiteboarding session included a collaborative development of the meeting’s agenda that would address Takeda Oncology’s goals and detail VSP’s unique capabilities as an IDN.

Pre-approval information exchange (PIE) was provided by Takeda Oncology to the VSP team to offer insight into the new medication, including outcomes from clinical trials. VSP then conducted an internal brainstorming session to discuss the unique value and capabilities they could provide for this specific medication.

The in-person whiteboarding session saw 18 staff from Takeda Oncology and VSP come together at Vanderbilt University Medical Center’s campus with the goal of optimizing pre-launch operations at both organizations to ensure patients prescribed this medication receive the best possible care. Takeda Oncology was represented by members from their Trade, Distribution & Payer Relations, Strategic Account Management, and Health Economics & Outcomes Research (HEOR) teams. VSP’s representatives included members from their clinic (clinical pharmacists in the launch space), operations leadership, data analytics, trade relations, and health outcomes and research teams.

Topics such as the provider and prescription journey, specific guidelines for management, and post-launch outcomes and operations planning were part of the agreed upon agenda that guided the brainstorming and work review. Throughout the day, each topic was given a dedicated block of time in which each organization contributed their priorities and methods to help develop deliverables to improve patient care.

During this time, both parties were able to showcase their expertise and discuss each topic from their viewpoint/position within the industry, as well as ask questions and gain insight into the goals and decision-making process of the other side. This unique level of transparency allowed for a better understanding of each side’s thought and decision-making process, with both sides believing this openness was a key contributor to identifying deliverables each side agrees will lead to the greatest outcomes for patient care while on this medication.

Figure 1. Topics Discussed During The Whiteboarding Session

By partnering with VSP, Takeda Oncology was not only able to establish a better connection to the specialty pharmacy and those managing the patients’ medication, but they were also able to receive unique insight into the patient and provider journey from a health’s system viewpoint. When mapping out the workflow between new medication referral and ongoing treatment monitoring, VSP illustrated how their embedded specialty pharmacy model helps patients achieve medication access and affordability, which aligned with Takeda Oncology’s launch strategy for fruquintinib.

VSP also demonstrated their tailored monitoring strategies to optimize therapy to ensure safety and efficacy, and how VSP is conducting patient-level outcomes research to support and improve clinical operations. Takeda Oncology was given a valuable perspective into real-world examples of barriers to medication access providers and patients face such as delays in approval of medication due to new drugs not being included in payer formularies upon approval and identified pain points for providers and patients, such as navigating HUB services.

By partnering with Takeda Oncology, VSP was able to better understand the strategic objectives and concerns of a manufacturer bringing a new medication to market, especially in a novel clinical setting for the manufacturer involving complicated treatment requirements. Specifically, Takeda Oncology provided visibility into the preparation and planning process when launching a new oral therapy.

This partnership also allows VSP to ensure better therapeutic outcomes for their patients by ensuring access to the product, having sufficient information about the product and treatment paradigms of mCRC, and proactively understanding and addressing potential access barriers involving the prescription journey. Additionally, working in collaboration ensures that efforts from both parties are efficient by minimizing duplicative activities.

To address the identified barriers, a series of deliverables were created with the goal of optimizing the delivery of Takeda Oncology’s new medication. By taking actions such as pre-loading drug information and reporting requirements into VSP’s electronic health record and prescription management systems and ensuring the medication’s distributor is set up to immediately recognize VSP as a member of the LDN, both parties aim to streamline speed to coverage and ensure treatment can be accessed as soon as the medication is launched.

An intervention plan is also being developed for VSP to utilize as part of a pharmacist-led tailored monitoring program designed to improve persistence through continual guidance on the management of adverse effects and prevention of unnecessary treatment discontinuation or reduction in drug exposure. Additionally, both parties are looking into improving the utilization of HUB services as another option to improve speed to coverage and reduce the number of potential reasons a patient may inappropriately discontinue therapy and are brainstorming patient outcomes research ideas centered around this modified delivery of care across the entire medication journey.

In the closing remarks of the whiteboarding session, both Takeda Oncology and Vanderbilt Specialty Pharmacy agreed on how beneficial they found this partnership, and how bringing the right mindset and embracing the opportunity to be openly collaborative while remaining committed to prioritizing patient care ultimately was the key for this success. Specifically, the whiteboarding session created an environment in which long-form discussions made it easy to further clarify goals and better explain the reasoning behind the decisions and viewpoints of Takeda Oncology (as a manufacturer) and VSP (as an IDN).

Through this unique level of collaborative discourse, Takeda Oncology received first-hand accounts of obstacles and pain points that prescribers and patients face throughout the patient journey and brainstormed with VSP on potential solutions to these barriers. This experience confirmed that Takeda Oncology’s revised approach to engaging with pharmacies integrated with health systems aligned with the strategic objectives of VSP. As a representative from Takeda concluded, “this was the best business-to-business process orientated meeting in [their] entire career.”

Beyond improving this specific product launch, this partnership made it evident that increased visibility and control of the patient and provider journey can be gained by all stakeholders when the willingness to collaborate across silos is present. Takeda Oncology and Vanderbilt Specialty Pharmacy ultimately concluded that this type of innovative, transparent partnership is the disrupter needed to progress the specialty pharmacy industry by utilizing the combined resources and viewpoints of manufacturers and health systems to ensure patients are receiving the best possible care.

References

1. Peter ME, Zuckerman AD, Cherry E, et al. Exploring healthcare providers' experiences with specialty medication and limited distribution networks. PLoS One. 2022;17(8):e0273040. Published 2022 Aug 15. doi:10.1371/journal.pone.0273040
2. Cherry E, Brown M, Renfro C. Making the Case for IDNs As Specialty Rx Innovators. SpecialtyPharmacyContinuum.com. Published April 13, 2023. Accessed August 9, 2023. https://www.specialtypharmacycontinuum.com/Operations-and-Management/Article/04-23/Making-the-Case-for-IDNs-As-Specialty-Rx-Innovators/69972