Characteristics of Successful Specialty Oncology Pharmacy Practices

In the rapidly changing specialty oncology space, accreditation, technology, data reporting, and customer service are some of the keys to staying ahead.

The specialty pharmacy market has become increasingly challenging, and this is forecasted to continue into the foreseeable future. Reasons for this include increasing competition for distribution of specialty oncology medications (SOMs) in particular. Additionally, more of these SOMs are being relegated to limited channels of distribution (LCD) to relatively few specialty pharmacy providers (SPPs), and profit margins for SOMs at the SPP level are decreasing. The body of scientific and clinical knowledge pertaining to oncology has grown in volume and complexity and this growth is expected to continue exponentially. Increasing reporting requirements for metrics associated with patient care, fulfillment turnaround time, and SRx utilization are also part of the challenge. SPPs must implement dynamic strategic and operational plans which will result in the SPP being top-in-class for provision of patient-centric care and pharmaceutical manufacturer satisfaction while generating adequate profitability.

The strategic and operational plans must be adaptable to the rapidly changing specialty oncology marketplace. Yet, even though some of the content of these plans may need to change (primarily the “how to get things done” parts), the context should not. The SPP must maintain its focus on providing the highest levels of satisfaction for internal and external customers. The following characterize SPP oncology practices which have demonstrated sustained success over their competition:

• Most SPP oncology practices have achieved or are pursuing specialty pharmacy accreditation by one of several nationally recognized accreditation organizations, with URAC accreditation being the most common. This is a testament to their commitment to the highest level of oncology practice, particularly given how resource intensive achieving and maintaining accreditation is.
• They have state-of-the-art information technology (IT) systems which integrate all aspects of pharmacy operations, including central intake, clinical services, fulfillment, delivery, continuous quality improvement (CQI), on-demand custom report generation, and management support functions.
• They periodically report their key operational and financial metrics for both management consumption and use in the SPP’s CQI programs. The reports are typically customizable to satisfy internal (eg, finance and accounting) and external (eg, managed care organizations [MCOs], pharmaceutical manufacturers) customer specifications and SPP contractual obligations.
• SPP oncology practices have centralized customer service operations that seamlessly and simply handle all customer and patient care needs, including connecting patients to appropriate patient support services whenever needed (eg, patient assistance programs [PAP] with customer service centers [CSCs] maintaining communication with patientsthroughout this process). Patients should never be left feeling as though they are on their own to overcome obstacles and access SPP services. Besides capturing patient demographics, doing benefit determinations, and guiding patients to and through PAPs, their CSCs also capture key clinical data which are referred to the clinical pharmacist for evaluation and use in patient counseling.
• Each respective staff member is experienced in and committed to oncology pharmacy practice. This includes having registered, even nationally certified, pharmacy technicians performing in CSC, prescription fulfillment, and supporting the clinical pharmacists. Some of their clinical pharmacists are board certified in oncology and have medication therapy management (MTM) certification from the American Pharmacists Association (APhA).
• These SPPs have sophisticated clinical practice support tools integrated into their respective pharmacy IT systems. These tools are designed to be patient specific and are regularly and routinely applied to each oncology patient and provide prompts to the clinical pharmacists for when to do clinical assessments. The more sophisticated SPPs have a tool that provides quantification of the risk of a given patient being nonadherent to their oncology prescriptions. Determining this risk factor drives the frequency and nature of the clinical follow-up reassessments, bringing particular focus on mitigation of medication-related problems and maintaining adherence to oncology prescriptions. Lastly, each member of the clinical pharmacy team is knowledgeable in and credentialed to perform risk evaluation mitigation strategies related to requirements for SOMs.
• In addition to having the above-mentioned clinical tools, most of these SPPs have a comprehensive MTM program. These MTM tools usually contain the APhA’s recommended documents. However, the more sophisticated of these tools are computer-based and also contain a nonadherence risk assessment instrument and an instrument to identify, assess severity of, and provide solutions to medication-related problems.
• All have clinical pharmacists available to any customer 24 hours a day, 7 days a week via toll-free telephone access.
• Most SPPs concentrating on oncology, which have moderately high volumes of oncology-related medications, also have a fulfillment system that is fully integrated into the pharmacy IT system. The fulfillment systems incorporate patient-specific radio frequency tags, conveyor systems, and state-of-art bar-code generation and scanning technology. All these are necessary to operate a perpetual drug inventory system, fill prescriptions, check fulfillment for accuracy and completeness, and facilitate delivery to the patient’s residence or prescriber’s office. The latter includes being able to print a copy of the proof-of-delivery document. The higher volume specialty oncology pharmacies also utilize reliable robotic prescription-filling technology (eg, ScriptPro), which is also integrated into the SPP’s IT system.
• Many SPPs concentrating on specialty oncology medications provide support services to MCOs by assisting them with driving patients to preferred drugs on the plan’s formulary. The more advanced SPPs specializing in oncology specialty drugs provide an outsourcing program via a service agreement with an MCO’s department of pharmacy. Here specially trained and often statecredentialed/ certified programs allow the SPP to provide prior authorization (PA) services for specialty oncology drugs that are on-formulary, using the MCO’s drug coverage criteria and PA forms. A minority of these types of contracts provide an opportunity for the SPP to recommend oncology drug coverage criteria for consideration by the MCO’s Pharmacy and Therapeutics Committee and assisting with developing and testing of MCO-sponsored PA systems, eg, PA websites for physician and pharmacy providers.

These plans, programs, and resources are either in daily use or are being developed for future use by successful specialty oncology pharmacies. It is, therefore, incumbent on SPP leadership to closely monitor these practice-critical trends and to implement those that make good business sense.

Royce Burruss, RPh, MBA, FASCP, has practiced full time in a variety of settings, having concentrated on specialty pharmacy for the past 14 years in clinical and senior management roles. He currently practices at OncoSource Rx as the director of clinical services. Prior to this he practiced clinical and administrative pharmacy in managed care, home infusion, retail, and hospital pharmacy. He has 11 active pharmacist licenses (Virginia, Maryland, Kentucky, Tennessee, Arizona, Louisiana, Nebraska, Oregon, Arkansas, Mississippi, and North Carolina) and he has led practices to successful JACHO and URAC accreditation. Since 1999, Mr. Burruss has been an assistant clinical professor of the University of Maryland School of Pharmacy. He is an active member of the American Pharmacists Association, American Society of Health-System Pharmacists, Academy of Managed Care Pharmacy, American College of Clinical Pharmacy, Fellow of the American Society of Consultant Pharmacist, and other professional societies. He has published in peerreviewed journals and has taught numerous courses on varied topics to pharmacy students. He graduated from Virginia Commonwealth University, Medical College of Virginia, School of Pharmacy with a BS in pharmacy and from the University of Richmond with an MBA.