Health Systems: Discovering Specialty Pharmacy

Due to their infrastructure advantages, health systems are well equipped to take on the challenges of specialty pharmacy.

Specialty pharmacy has attracted the attention of health-system pharmacy in a big way. A quick glance at the URAC list of specialty pharmacy—accredited companies provides confirmation of this assertion.

As of April 2015, URAC listed 12 health-system pharmacies with full accreditation for specialty pharmacy,¹ and more than twice that number are currently going through the process of specialty accreditation. At the recent 2015 Armada Specialty Pharmacy Summit, one observer blogged that health systems are now targeting specialty pharmacy for rapid growth.²

Health systems’ interest in gaining entry to the specialty-pharmacy market should not be a surprise, considering that specialty drug sales are growing at rates reported to be approximately 19% per year. From a financial perspective, hospitals and health systems are averse to seeing these revenues leave their systems—and their bottom lines.

Furthermore, the 340B pricing program could offer substantial incentives to certain qualifying health systems when they retain specialty-pharmacy prescriptions. Add in the trend of health systems’ entry into risk-sharing contracts, the formation of accountable care organizations, and the consolidation and merging of specialist physician practices into the systems, and it becomes apparent that a focus on specialty pharmacy makes sense for health systems.

Health systems bring a number of advantages to the specialty marketplace that payers and manufacturers may soon recognize as significant. For example, full integration and availability of clinical information to multidisciplinary health care providers allows for a level of care coordination that is unlikely to be matched by unaffiliated pharmacies.

The accessibility of clinical data through the electronic medical record (EMR) affords advantages in processing authorization requests prior to service that should result in shortened approval turnaround time and faster initiation of treatment. The access to a full clinical data set through the EMR provides health-system pharmacies with broad advantages in their ability to produce the reporting necessary to demonstrate clinical outcomes and quality of care.

By virtue of an integrated approach, specialty pharmacies operating within the health system may be better able to leverage partnerships with specialist physicians and coordinate care. Patients will be able to recognize the greater ability of pharmacists working within the health system to connect and communicate patient concerns, adverse effects, and medication adherence to their health care team.

As a result, the integration of health-system specialty pharmacists with the patient’s health care team is expected to have positive effects on patient satisfaction. Certainly, health systems will face challenges in competing with established specialty pharmacies.

In some cases, health-system specialty pharmacies will need to provide evidence of their capabilities to pharmaceutical manufacturers in order to obtain desired access to certain limited-distribution medications. Using available data to prove outcomes through effective use of the EMR may prove to be persuasive in some cases.

Leveraging the influence of key physicians and adopting formulary principles to certain specialty therapeutic groups—an emerging trend—are additional tactics available to health systems that can be used to make the case for access to some limited-distribution medications. Health systems first need to develop expertise in optimizing payer contracts.

Payers will then begin to see value if integrated health systems can demonstrate positive clinical outcomes for their specialty patient populations, and therefore will elect to include accredited health-system specialty pharmacies within their specialty networks. A major challenge for health systems is the development of robust reporting capabilities and compelling outcomes data.

As mentioned previously, however, health-system pharmacies appear well positioned to do so. Which health systems should ultimately find success in the specialty pharmacy space?

A health system employing a forward-looking pharmacy director with the ability to articulate the importance of specialty pharmacy to system leadership and then acquire and mobilize the necessary resources within the pharmacy department will likely do well. Established outpatient or retail-pharmacy experience—including a full understanding of prescription claim processing, prescription benefit programs, and ability to obtain patient financial assistance—is a critical determinant of success.

Attention to payer contracting cannot be overlooked. If a health system does not possess each of these factors or does not wish to make the necessary commitment to build them, then that system might be receptive to partnership opportunities with an existing specialty within its service area.

Observers of the specialty space have taken notice of health systems’ interest in specialty pharmacy. Due to their infrastructure advantages, including the vast benefits of a fully integrated EMR, health systems seem to be well positioned to compete.

Despite some challenges, expect more systems to pursue entry into this highly competitive space and for health-system pharmacy to begin demonstrating the obvious advantages of specialty care integration. SPT

References

• URAC Accreditation Directory. www.urac.org/directory/DirectorySearch.aspx. Accessed May 29, 2015.
• Fein AJ. Specialty pharmacy’s bright but complex future: seven reflections on #Armada 15. Drug Channels website. www.drugchannels.net/2015/05/specialty-pharmacys-bright-but-complex.html. Accessed May 28, 2015.

About the Author

Jim Motz, RPh, is manager of the specialty pharmacy program at Aurora Specialty Pharmacy in Elm Grove, Wisconsin.