The Financial, Clinical, and Human Role of Specialty Pharmacies in Ambulatory Infusion Centers

In the never-ending quest to reduce health care treatment and delivery costs, more and more payers are deploying site-of-care (SOC) optimization strategies. SOC strategies examine where care takes place and how the location can reduce cost while not compromising the quality of care and patient outcomes. Increasingly, SOC strategies are nudging patients out of hospitals and into ambulatory centers to receive certain therapies, and pharmacists who work at these sites are invaluable in contributing to a positive treatment experience.

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Financial and Clinical Value

To support patients who need specialized treatments such as chemotherapy and antibiotic infusions, specialty pharmacies that partner with or operate ambulatory infusion centers (AICs) are positioned as a cost-saving alternative to hospitals. The global AIC market size was valued at $75.4 million in 2023 and is forecasted to reach $133.6 million by 2031, with a compound annual growth rate (CAGR) of 8.5% during the review period.¹

According to the National Association for Health Insurance Providers (AHIP), the cost savings realized when patients receive care outside of the hospital are significant. AHIP found costs per single treatment for drugs administered in hospitals were an average of $7000 more than those purchased through specialty pharmacies.² On average, hospitals charged double the price for the same drug when compared to specialty pharmacies.²

Ambulatory infusion centers (AICs), especially for patients who are immunocompromised or who need regular infusions for chronic conditions such as multiple sclerosis (MS), are a crucial part of the SOC shift. Treatment for such conditions can be extremely costly throughout a patient’s lifetime, and AICs can help reduce that cost for payers as well as patients.

Consider a patient diagnosed with an infection who is admitted to the hospital to help manage symptoms. Upon further testing, this patient is found to have Guillen-Barre syndrome (GBS) and requires a loading dose of immunoglobulin therapy. The hospital admission for this patient may include a 5-day hospital stay, at the cost of roughly $125,000. In addition, valuable inpatient staff members must care for the patient at a time when all hospitals are short-staffed. This admission may also prevent other patients from receiving care only a hospital can provide.

As a safe and effective alternative, this patient, once stabilized, could receive the immunoglobulin therapy loading dose at an AIC or in the patient’s home with the support of a nurse––for a fraction of the cost to the payer and the patient. It may also provide a more comfortable environment for the patient.

Providers who can adjust quickly to this care delivery paradigm and utilize the knowledge of specialty pharmacies will experience financial and care quality advantages.

Human Value

Many patients appreciate the sense of community––from the physicians, nurses, and other patients––they experience at an AIC. Plus, specialty pharmacists are always available to the patient and clinical team with extensive knowledge about the medication/treatment being delivered, helping guide the safety and comfort of each patient’s care and treatment plan. They also provide patient education and clinical support, including valuable information about treatment management, adverse effects, and compliance monitoring.

Some patients may benefit from more flexible scheduling offered at AICs. Those living in rural areas may not have to travel long distances to a hospital for treatment if there’s an infusion center closer to home. For the immunocompromised, it may also mean less risk of hospital-acquired infections (HAIs), which is no small matter, considering that on any given day, about one in every 31 patients hospitalized in the US has an HAI.³

Patients with chronic conditions like MS or cancer may find an AIC less overwhelming and “scary” than a hospital-setting for their therapies/treatments. Those patients may even develop a sense of camaraderie from knowing other patients with the same condition in a more intimate setting.

“Patients who are undergoing chemotherapy or other infusions or specialty treatments for their conditions are often dealing with a lot of physical and emotional challenges relating to their illness,” said Cecilia Choi, MD, an oncologist at Maui Care Physicians who refers patients to Hawaii Specialty Pharmacy’s 2 AICs in Maui, Hawaii. “Logistical challenges should not be added to those burdens. I’m so glad to have a welcoming, convenient option to offer my patients.”

As an industry, we must continue to recognize the financial, clinical, and human value of evolving our approach to where and how patients receive care. Because good health––and a positive health care experience––looks different for everyone.

REFERENCES

1. Latest Business Trends and Insights. “Ambulatory Infusion Center Marlet.” LinkedIn, January 18, 2024. https://www.linkedin.com/pulse/latest-ambulatory-infusion-center-market-xni0f/

2. AHIP. “New Study: Hospitals Charge Double for Drugs – Specialty Pharmacies More Affordable.” AHIP, February 16, 2022. https://www.ahip.org/news/press-releases/new-study-hospitals-charge-double-for-drugs-specialty-pharmacies-more-affordable

3. Centers for Disease Control and Prevention. "Healthcare-Associated Infections (HAIs)." Centers for Disease Control and Prevention, 29 Aug. 2024, www.cdc.gov/policy/polaris/healthtopics/hai/index.html.