Community Specialty Pharmacy: The Time Is Now!

When specialty pharmacists refine their skills and adapt their methods of providing services to patients, they are directing their own destinies and taking on a valuable role in the community.

The health care environment is in a dynamic state of evolution and accelerating change. Just as technology becomes more sophisticated and access to information quickens, demands upon and changes to the delivery of health care are impacted.

There are tremendous financial pressures impacting all segments of the health care industry. In response to the demands of very informed and sophisticated purchasers of health care services, competition within the industry requires health care value to be delivered at the lowest possible cost. As a provider of health care services, pharmacists should understand the demands of the industry, which are driven by a very savvy and powerful purchaser or purchasing groups. To meet those demands in a cost-effective manner, community pharmacists must adapt their methods of providing health care services.

The community pharmacy and pharmacists have played a very active role as a key component of the health care delivery system to date. Today, the community pharmacy is being impacted dramatically by the changes occurring within the managed health care industry.

Present Situation

There are several factors impacting the practice of the community pharmacy in today’s managed care dominated industry:

• More Informed Consumers

The ultimate purchaser of health care services is becoming more informed about his/her opportunity to demand lower costs and increased services. As purchasers expand their knowledge and network, the broader view better positions them for further cost containment.

• Political and Governmental Pressures

While we are in the middle of formalizing health care reform, the government is pressuring private industry to address the management of health care services and take control of the rising cost of health care within our country.

• Price Pressures

The pharmacy being viewed as a commodity distributor of prescription products only forces managed care organizations to direct costs using a short-term approach. The advent of highly competitive pricing with generics and the predominance of available cost-effective therapies only add to the pressures. Managed care will continue to demand lower prices for products and services from their pharmacy providers.

• More Service Without More Cost

Demands are increasing for pharmacy providers to deliver higher service levels with lower reimbursement provided for those services. Operational costs for pharmacy are rising at the same time.

• Increased Specialty Products and Restricted Access to Them

One need not look too far to understand the evolution of the product mix from brands to generics to a predominance of newly approved products migrating to the specialty category. Many of these products will be positioned in the market with restricted access, thereby potentially locking out community pharmacy.

• Need for Assistance to Move into the Future

Pharmacy leadership believes forward-thinking managed care payers are seeking assistance in managing their rising health care delivery costs. That assistance will be sought and accepted from whatever organization can effectively deliver on those health care cost management tools. The challenge is for pharmacists to refine their skills and resources in a manner that assures delivery.

Choices and Challenges for the Profession of Pharmacy

• Stay With Today

Community pharmacy can accept the current role of being a volume-driven prescription commodity dispenser, subject to the management of:

• Payers
• Pharmacy benefit managers
• Specialty niche health benefit management companies

• Find a Special Niche

Community pharmacy can develop unique market-driven niche opportunities either within or outside of health care. Appropriately managed, these pharmacies may be able to command and receive a higher payment within the industry. The number of these opportunities will be self-limiting, however.

• Focus on Patient Needs

Community specialty pharmacy patient care programs do create opportunities for community pharmacy to assume their appropriate role of managing patient care services for their patients. Short-term, the focus must be on the needs of the patient and the improvement of outcomes.

Focus on Specialty Pharmacy in the Community

The management of these services by the development of a community specialty pharmacy network is a cooperative effort between the pharmacist and payer. This will assist in achieving the mutual cost containment goals and at the same time provide fair reimbursement opportunities for those community specialty pharmacy network providers delivering true value to a specialty program.

A cooperative effort approach between the payer and providers must replace the current adversarial situation existing today. A community pharmacy specialty network approach should actively market the specialty care programs directly to the payers and seek fair reimbursement for documented services.

Community Specialty Pharmacy Network Vision

Community specialty pharmacy has the opportunity to direct its own professional destiny by taking charge of pharmaceutical care services offered to the patients and payers. A focused credentialed network program should be designed to allow community specialty pharmacies the opportunity to develop and administer a patient care programs on behalf of and in partnership with the patient and payer, which is unique to the needs of their marketplace.

Retail or community pharmacies are often in the best position to understand the needs and opportunities of their local communities and patients. A focused community-based specialty pharmacy is very well positioned to interact with the local physicians in a cooperative effort to provide health care services to their mutual patients and payer.

Opportunities and Goals

There are several goals that the credentialed network of community-based specialty pharmacies can establish in cooperation as a component of the delivery of patient care services and the partnership with patients and payers:

• To validate the value that the community-based specialty pharmacy network provides to the patient and payer
• To assure the long-term success of pharmacy
• To transition pharmacy out of its role as a prescription commodity dispenser into the established role of a pharmaceutical care provider
• Long-term, to create an effective and credible partnership with payers to provide the highest possible pharmaceutical care value to patients while meeting the cost containment goals of the payers.

What Is Your Plan of Action?

There are several organizations in the market today that are experts at building out a solution for community-based specialty pharmacy. There are several elements that come into play that you may consider including:

• Scope of build-out Pharmacy size Product focus Value proposition Licensures and permits

• Infrastructure and full-time equivalent (FTE) requirements Pharmacist-in-charge (PIC) Reimbursement Patient intake Customer service Pharmacy technicians Pharma account managers

• Project plan and Gantt chart Establish build-out items Timeline and business owners Communication schedule

• Pharma/managed care/group purchasing organization (GPO) strategy Go-to-market strategy Product focus Identify target hit list with which to hold meetings

• Sales and marketing recommendations
• Budget development and management strategies

Summary

Currently, community pharmacy has a strategic advantage because it already has the broadest network of pharmacy outlets in the United States market today—and consumers generally know and trust their community pharmacist. It stands to reason that when given the choice of maintaining a professional relationship with their local pharmacist for specialty products, community pharmacy is the choice patients will make over other providers.

The brand recognition of a community pharmacy in each of its marketplaces cannot be easily replicated by other providers. Community pharmacy already has the advantage of:

• Being patient-management based, with a focus on professional services
• Local relationship with patient and physician community
• Key relationships with the manufacturer for purchasing power
• Reporting capability by capturing data currently lost within medical benefit
• Potential tie-in of financial management services. SPT

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Dan Steiber, RPh, is a principal of D2 Pharma Consulting LLC (d2rx.com) and is responsible for commercial operations, trade-supply chain strategy development including 3PL selection, regulatory oversight, and “operationalizing” organizations. Dan has served in several senior positions in pharmacy, distribution, and industry over the course of his 35-year career. He is a licensed pharmacist in Texas, Washington, California, and Pennsylvania and is affiliated with several professional associations and publications and a frequent speaker on behalf of many professional organizations. Dan graduated from Washington State University College of Pharmacy and has participated in a variety of postgraduate programs in law and business development/marketing at Harvard University and Northwestern University. Dan currently resides in Highland Village, Texas.