Specialty Pharmacy: Where Patients are a Name, Not a Number

What unique services does each specialty pharmacy provide?

What is the most appealing aspect to providers and patients? The majority of providers and patients would list clinical programs and clinical outcomes as their primary metric to which each specialty pharmacy is gauged.

Can a large specialty pharmacy with access to every specialty therapy and health plan provide the same level of clinical programs as the small start-up specialty pharmacy? Will the start-up have enough resources to support their patients fully? Who will regulate and standardize the care standards between the two?

These questions are just a few that consistently are discussed due to the large price tag associated with each specialty prescription. Specialty pharmacy patients are each unique, and it would be next to impossible to find two that are identical.

Each patient has a different knowledge set, and comprehension of their therapy and disease. The initial encounter between a patient and a specialty pharmacy is crucial to the long-term success of the partnership.

Clinical programs are in place, because if the patient was not comfortable and trusting in the staff, then they would deny having any questions or concerns about their therapy, and only run into additional problems to their care. The truth is that patients need clinical programs and clinical measures more than they realize.

Patients often have to be educated before they can formulate questions about their therapy. Many patients are still recovering from the fact that they were just diagnosed with a life changing disease. As a result, the counseling the prescriber may have given them after the diagnosis is all but a blur. The patients who are triaged to the specialty pharmacy need a lot of resources, and the information must be clinically appropriate and accurate.

Specialty pharmacy accrediting bodies, such as URAC, ACHC, and CPPA, guarantee that certain measures are in place for patients to reach their therapeutic goals. The overseeing organizations have incredibly detailed standards that must be met to prove a specialty pharmacy's commitment to their patients, and to quality-of-care. Each patient is treated appropriately to confirm that each stakeholder involved is not negatively affected, financially or clinically.

Defined clinical programs are necessary to make sure the patient is being serviced from a multi-disciplinary approach, not just treated as a prescription number with a high price tag. A patient's clinical program starts off with the initial contact from the specialty pharmacy.

This initial contact is an opportunity for basic demographic information to be exchanged to construct an accurate profile. Once complete, the prior to therapy assessment must be generated.

At this stage, a pharmacist or nurse can ask probing questions to build a clinical profile, which can include additional medications, diseases, and the patient's support network and resources. Next, the therapy itself needs to be reviewed in detail.

The information about each treatment must be conveyed in a way to educate the patient but not terrify them, even if the therapy is intimidating. Patients must be aware of all pertinent information, including storage, administration, side effects, and the goals of therapy.

Comprehensive assessments can flag many therapy issues that can prevent wasted or inappropriate medication use, which can save both the patient and the health plan unnecessary expenses. The initial assessment is essential to start therapy, but the majority of therapeutic concerns occur after starting therapy.

Clearly defined follow-up assessments must be built into the clinical programs to safeguard the patients throughout the entire treatment process. For example, oral oncolytics should only be dispensed as an initial two-week supply, with a specialty pharmacy intervention built-in that can re-evaluate whether the therapy is appropriate.

If a patient cannot tolerate therapy at this stage and discontinues therapy, the specialty pharmacy just saved the patient and the health plan unnecessary costs. Other therapies will only require quarterly, or as needed assessments, based on the medication and the disease state, but all will require specific questions to be completed. There are many steps to initiate and maintain therapy, but how do clinical programs improve patient outcomes?

Clinical programs serve many different aspects to a patient's overall wellbeing and treatment plan. One is they simply keep a patient's refills on time, and increase their PDC rate. Another is they ask probing questions to look for any apparent or hidden therapy concerns that can be addressed immediately.

Specific assessments can keep specialty pharmacies on track to gather key lab values and performance metrics to keep patients protected. Perhaps the most important assessment that must be completed is the patient's quality-of-life assessment.

The quality-of-life assessment gives an accurate depiction of how the patient feels during therapy. Let's discuss a psoriasis patient who is prescribed a TNF inhibitor that does not cause any side effects or administration concerns, and is a zero-dollar copay; however, the patient still has significant plaques on their body.

This treatment could not be considered a successful therapy if the patient's quality-of-life is suffering due to their symptoms not being resolved. Clinical programs are in place to ensure that patients receive the most optimal care possible. Each patient is completely different from one another, but concrete clinical programs should be able to handle each unique need.

Often, patients do not know enough about their medications to formulate questions, therefore, probing in-depth questions must be in place to extract how much the patient does and does not know. The costs associated with specialty therapies makes clinical programs necessary to block any unnecessary medication costs, and ensure patients have the highest quality-of-life possible.

About the Author

Anthony Mazzarese is a graduate of The University of Pittsburgh School of Pharmacy, and 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. He is the Pharmacist-In-Charge at Giant Eagle Specialty Pharmacy. His practice is focused on improving medication compliance and overall wellbeing in the areas of HIV, auto-immune disorders, oncology, and organ transplantation.