Specialty Pharmacies: The Health-System Perspective

The changing health care environment and the integration of specialty pharmacies into health systems were the biggest themes during one of the liveliest panels at the Therigy conference last month in Orlando, Florida.

In his opening remarks at the Therigy Specialty Pharmacy Leadership Congress held October 22 to 24, 2013 in Orlando, Florida, Therigy CEO and Chief Clinical Officer Russel Allinson, RPh, MS, pointed out that the management of specialty pharmacy works a bit differently in the health-system setting. He said that the majority of specialty drug research is conducted by clinical investigators at academic medical centers, and specialists or subspecialists write a large number of specialty prescriptions in a health system. Specialty pharmacy clinicians in academic medical centers have a unique advantage in that they have access to full patient EMRs (electronic medical records) and to patients at discharge and ambulatory clinics. Additionally, he mentioned that with changes to Medicare reimbursement, health systems are seeking to capture new revenue opportunities within the system—and these opportunities could lie within the management of specialty medications.

According to Allinson, there are 4 different “approaches to the development of specialty in health systems”: programs that are internally developed, funded, and implemented within the hospital; health systems with a health system—sponsored specialty pharmacy initiative; those that have a business partnership with an existing specialty pharmacy (ie, a front-end to back-end type of arrangement); and those that employ an outsourced entity for all of their specialty medication needs.

Following the opening remarks, panelists from the field weighed in on some tough questions from Allinson. In response to a question about how specialty pharmacy fits into the strategy of a health system, Willis Chandler, MBA, executive vice president and COO of Shields Pharmacy Services, asserted that health systems need to integrate care better. He pointed out that, often, intensive care pharmacies are embedded within the health system’s plan of care—and if this method has worked in the past, health systems should have the capability to intensively manage outpatient care as well.

In terms of how specialty pharmacies should fit into the strategy of Affordable Care Organizations (ACOs), Harlan Langstraat, RPh, vice chair of medical products division at the Mayo Clinic, said that specialty pharmacy plans should include post-dismissal pharmacy care to avoid a “soft transfer into a dark hole.” He said that we often don’t know what happens to a patient after discharge, and this creates an environment of fragmented care. Specialty medications and routine medications often come from different places, further disintegrating patient care, he said. Because of exclusive contracting arrangements, there can even be different specialty pharmacies for different specialty drugs within the same health system.

Panelists also spoke of the challenges they face getting a health system into limited distribution specialty pharmacy networks. Becky Rand, senior director of trade relations at Premier Healthcare Alliance, commented that limiting channel distribution when a health system is trying to function at a local level makes it hard to appropriately service patients. Health exchanges, she said, will add a whole new level of complexity: “Payers and manufacturers should get on the same sheet of music,” she quipped.