The Need for Standards in Specialty Pharmacy Data

As technology evolves, data continue to be a key component of patient care in the specialty pharmacy (SP) landscape.

Several services within SP are data dependent, with many of them being measured from an aggregate level, such as inventory control and patient services. In a session presented by Pharmacy Times Continuing Education™ at the Asembia Specialty Pharmacy Summit 2017, a panel moderated by Specialty Pharmacy Times® editor-in-chief Dan Steiber examined the current landscape of SP data, differences in types of data, touchpoints in the collection process, and the roles of various stakeholders in the specialty space.

From a specialty prescription flow perspective, once an SP receives a prescription, it must perform certain tasks for a benefit investigation through claims submission. Eventually, the SP wants to a claim paid and to make sure the patient starts treatment. Therefore, the SP sets up the shipment for the patient and then goes into an adherence loop in which, month to month, it coordinates with the patient to ensure adherence and to monitor the response to the regimen, according to the panel. This prescription flow is significantly different from the actual data flow, which is much more complex.

“There are a number of characteristics that we can capture at those points in prescription management that are intransient to what becomes a part of a specialty data intervention,” said Jonathan Ogurchak, vice president of business operations at PANTHERx Specialty Pharmacy. “Things like demographics, benefits information, [and] what the prescription/claims submission looks like. But from those elements, you can start to extrapolate and analyze that data.”

What if SPs do not follow this so-called happy path? What if they worked with a data hub to capture the prescription instead of receiving itdirectly from a physician? “We still get all that valuable data, but it’s more that we need to capture, it’s more that we need to eventually pass on,” Ogurchak said.

Manufacturers also are seeking to capture these data to understand what is going on with their patients; the hub could pass the data directly to them. In addition, because SPs will have multiple contracts, and in order to participate with their payer-owned counterparts, they need to have at least 1 accreditation, sometimes more. Therefore, the data will need to be passed back to accreditors, who will examine the data and check to make sure the SP meets accreditation standards.

“Having accredited standards means that we have to follow certain clinical pathways,” Ogurchak said. “Those clinical pathways provide very valuable disease outcomes-based evidence of what we’re looking to do to manage these patients. That is something that is going to be valuable to the payer and the accreditor, just to be compliant with them.”

In cases in which the patient is not adherent or does not continue therapy, SPs can capture another set of data. These data will be valuable because they will provide information on why the patient discontinued treatment and what the adverse events were.

“[This] is very crucial information that can be captured at the SP level,” Ogurchak said.

The primary goal is to see how patients are using their drugs. SPs can use the data to improve communication with physicians and ensure that the best possible outcomes are being achieved. Unfortunately, there are several challenges that exist and need to be overcome in this area, according to the session. SPs can choose any type of technology platform available, but may not be able to ensure their software can capture these data points.

Ogurchak noted that standards in this area are virtually nonexistent—other than requirements from the National Council for Prescription Drug Programs—in order to submit a claim to a payer for reimbursement. Once the data are obtained, appropriate use needs to be determined to ensure value. Because there are numerous ways to examine these data once captured, standardization of the analysis needs to be put in place.

“One challenge [is] we need some capability, we need that actual infrastructure to be able to capture, act upon, and report on all of these data elements we’re able to accrue as a specialty pharmacy,” Ogurchak said.

Another challenge is how to “play nice” across multiple third-party data partners. SPs need the ability to transmit the data and set up different frequencies of transmission. They need systems to transmit the data appropriately.

Lastly, the data should not be put on a shelf, but rather used to drive operational improvement; however, a benchmark is needed to see how an SP is doing compared with other entities.

“We need to be able to show that the data we capture can be benchmarked,” Ogurchak said. “Right now, there aren’t those standards across the industry, necessarily, to benchmark ourselves.”

For the future, SPs need to get as close to real-time data as possible to know what is going on with patients as they go through their treatment journey.

“If we capture these data and then sit on it, then there’s really nothing that can be done today to make a patient’s life any better,” Ogurchak concluded.