Data Mining Vital to the Future of Specialty Pharmacy

Data collection and mining is essential to the progress of specialty pharmacy.

Clearly, pharma will keep pushing forward with data requests and reporting mandates, and therefore pharmacies that can keep up will win more business. Also, it wouldn’t be surprising if accrediting bodies began to focus on data reporting capabilities as well, to further raise the bar for the industry.

Claims level data is a must for all pharmacies, but it only scratches the surface of what specialty pharmacy is able to provide. Outcomes-based payment models are here to stay, and the ability for a specialty pharmacy to provide a deeper look and stronger support of outcomes will benefit patients, payers, prescribers, and manufacturers.

The basic claims level data, including NDC number and prescriber NPI number, will not be enough to compete in the future with greater data requirements. It is necessary to ensure that current data are reproducible and easy to categorize, store, and sort.

The ability to add data points to each step of the process in filling a script is already valuable. Key stakeholders, including payers and manufacturers, want to know what a specialty pharmacy’s time-to-fill is. When the specialty pharmacy can break down the steps, the pharmacy is able to give a clearer picture of the value provided by servicing patients.

In addition to prescription fill data, clinical and outcomes data will become more and more valuable. Manufacturers want to be able to publish evidence of their drug’s worth in ongoing trials, and a specialty pharmacy’s ability to deliver key clinical data will streamline the process for manufacturers, and make the specialty pharmacy an asset moving forward.

If a pharmacy can capture fibrosis scores, genotypes, and quantified patient reported measures, and then attach that to a script fill, the pharmacy will not only be providing greater evidence of worth to health plans and manufacturers, but also will be able to capitalize financially as a result. The ability to effectively manage patients, coupled with the ability to provide sortable evidence supporting patient care, will allow specialty pharmacies to command a higher dollar value for their data.

The financial reward for stocking medication, and efficiently dispensing it, may be less than the reward for returning information tied to caring for the patient in between refills. It is reasonable to expect that dispensing patterns could be predicted based upon trends in reported side effects, lab values from bloodwork, or even prescriber evaluation of the patient.

If a drug company knows there is a point where a block of prescribers switches from one product to another based upon prescriber notes, they will be able to better allocate resources to supply chain and marketing efforts. A specialty pharmacy can provide access to this data if they have a strong relationship with prescribers, electronic health records, and labs.

The trick will be to effectively quantify data in a manner that can be sorted and interpreted. For example, creatinine values may not need to be explicitly known, but a range or trend would be useful for reporting purposes.

If a pharmacy has access to electronic health records, and can preemptively perform a benefit exploration based upon prescriber documentation, then time-to-fill could be shortened. It is clear that superior data will allow a specialty pharmacy to rise above peers in the eyes of manufacturers, but it will also help lead to better outcomes for the industry as a whole.

If specialty pharmacy can proactively set the bar higher on reporting back to monitoring agencies, then the industry will be put in a position to help shape the future, as opposed to be at the mercy of regulation. Specialty pharmacy could potentially report classification of an organism, and confirm susceptibility prior to dispensing future classes of antibiotics, which could slow the spread of mutating drug-resistant virus and bacteria.

Specialty pharmacy will be in a position to confirm genotypes and monitor outcomes when these drugs are dispensed. There is every reason to believe that the benefits of drug therapy in the post-marketing setting will become realized, which likely were not tested in trials ahead of time.

By more quickly identifying patient health trends after drug approval, outcomes benefits may be multiplied, as prescribers will have a clearer picture of how to treat patients. Because specialty pharmacy is at the intersection of patient and industry, the profession is in the unique position to shape the future of health care.

By providing more drilled down data, analysis previously unrealized will grow and benefit all stakeholders.

About the Author

John Meehan earned his PharmD degree from Duquesne University in 2010. John worked in retail pharmacy in rural North Carolina before transitioning to a clinical pharmacist position at Chartwell PA in Pittsburgh, PA. John is currently enrolled in the Masters of Science in Pharmacy Business Administration (MSPBA) program at the University of Pittsburgh, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines.