The Value of Data in Specialty Pharmacy

Data have different meanings and value for each of the key stakeholders in specialty pharmacy. Understanding the needs of each group will help improve outcomes and reduce expenses.

Whether it is in politics, business, or within your own family, it seems that everyone has their own wants and needs. The specialty pharmacy world is no different. With 5 key stakeholders in specialty pharmacy—patients, physicians, pharmaceutical manufacturers, pharmacy benefit managers (PBMs)/health plans, and specialty pharmacy itself—everyone has different motivations. This article will discuss how various data elements in specialty pharmacy can help every stakeholder satisfy their needs.

Patients

Specialty pharmacy patients are dealing with complex disease states, which can be frustrating and confusing as patients routinely deal with multiple health care providers. Specialty pharmacy patients not only want to improve their health and be confident that their medication is safe, they also often require more in-depth pharmacist-provided education, continuity of care, and speedy delivery of their medications. The data elements, such as interaction and allergy assessment tools, for example, and the ability to capture Risk Evaluation and Mitigation Strategies (REMS) data, and clinical laboratory tracking software, are all essential for ensuring therapy safety and efficacy. By using baseline data and comparing it with the data collected throughout the patient’s treatment, specialty pharmacies are able to measure and validate a patient’s response to therapy. Through the use of systematic call reminders, pharmacists and patients are connected so that patients receive the in-depth, specialized education that is a hallmark trait of specialty pharmacy.

The clinical data available to the pharmacists in a specialty pharmacy make this customized education possible. Copay programs and coordination of multiple insurances also help to alleviate financial burdens for many patients. Patient progress note tracking and care plan data fields ensure continuity of care from pharmacist to pharmacist. Specialty pharmacy affords patients the ability to obtain medications that would not be available at their retail pharmacies. Having integrated shipping and package tracking software is fundamental in assuring prompt and accurate delivery of drugs to the patient.

Prescribers

In addition to patient adherence and improved health outcomes, prescribers also want access to their patients’ clinical data with minimal hassles from insurance companies and outside parties when prescribing. It has been proved that pharmacist involvement in patient therapy improves adherence. By having systematic, routine interactions with specialty pharmacists, nurses, and support staff, physicians can be assured that their patients are receiving regular follow-up calls, thus increasing compliance.

The claims data can be used as a marker of patient adherence rates, and more advanced compliance assessments can identify and mitigate specific patient challenges that impede compliance. By having integrated clinical and laboratory data available at their fingertips, pharmacists are less likely to call physicians for clarification. Other data elements, including prior authorization and copay assistance support services, also minimize questions for physicians.

For example, imagine that a physician prescribes the osteoporosis medication Forteo for their patient. The specialty pharmacy processes the prescription only to learn that the patient’s copay is $150, and the patient cannot afford the drug at this price. The patient also has questions about the Forteo Patient Registry Program and her bone density scores. The copay assistance support, laboratory data tracking, and clinical data at the specialty pharmacy allow the specialty pharmacist to manage all of the patient’s needs and concerns without numerous calls to the physician. Prescribers may be able to gain access to patient data through the use of web-based data sharing systems. These data elements can reduce administrative time for physicians and allow them to spend more clinical time with their patients.

Pharmaceutical Manufacturers

Pharma’s goal is to ensure full and successful treatment for the right patient at the right time. Pharmaceutical manufacturers want improved patient access to medications and up-to-date drug utilization data. One of the key data elements that can help pharma meet its needs is de-identified dispensing data. From this data, shipment trends, medication adherence statistics, and inventory management data can all be obtained.

The pharmaceutical industry is interested in targeted physician detailing. Utilizing specialty pharmacy—provided physician dispensing data, drug utilization data, and de-identified patient demographic data leads to more effective use of their products. Unlike retail pharmacy where there is limited utilization of many drugs across thousands of pharmacies, specialty pharmacy dispenses many prescriptions of a particular product in a very limited number of pharmacies. Having inventory logs and turnover data can help pharma determine how to best manage its medication distribution and identify unmet needs that require further analysis.

PBMs/Health Plans

PBMs and health plans may gain more from specialty pharmacy data elements than almost any other stakeholder. With an increasing percentage of drug spend going to specialty drugs, cost savings and avoidance are becoming even more attractive for PBMs. With the passing of the Affordable Care Act, using clinical data to correlate medication use with improved health outcomes is more important than ever, since reimbursement may be tied to these data.

Clinical and patient demographic data can provide for cost savings in other ways as well. For example, Synagis, the medication used to prevent respiratory syncytial virus (RSV) in infants, is available in 50 mg/0.5 mL and 100 mg/1 mL vials and is dosed based on the patient’s weight. By using demographic data gathered from the patient, specialty pharmacists can ensure that the correct amount of drug is sent to the patient, thus minimizing waste and reducing drug spend for health plans. Claims and lab data enable specialty pharmacists to provide ongoing education to patients on maintenance medications, which can increase adherence and prevent costly medical care later in the patient’s life. These medication adherence rates can be verified by the PBM through claims data.

Specialty Pharmacy

Finally, the data elements responsible for meeting the specialty pharmacy’s needs must be addressed. While the specialty pharmacy is interested in safety and efficiency when dispensing prescriptions, it also wants patients to be adherent to therapy and satisfied with the services being offered. Specialty pharmacies are equipped to capture data elements to meet these varying needs. Integrated drug database and interaction software, prescription imaging, HIPAA tracking, and automatic patient follow-up and refill reminders all enable the pharmacy to meet its prescription accuracy and efficiency needs.

It is the benefits investigation, automated billing, claims adjudication, and copay/prior authorization assistance support programs, however, that allow the pharmacy to ensure that patients receive the lowest out-of-pocket costs. By utilizing reimbursement support and clinical management programs, specialty pharmacies are able to increase patient satisfaction. For the future, specialty pharmacy needs to plan for Accountable Care Organization implementation by having the ability to provide clinical information to other medical professions that may interact with their patients. These clinical data models are now in development—and they will also provide the specialty pharmacy clinical staff with access to new clinical information that will assist in their patient management efforts.

Various stakeholders all see different value in the data elements present in specialty pharmacy. The unique blend of clinical, inventory, billing, patient demographic, and medication regimen data is able to satisfy the needs of every stakeholder. With the increasing number of specialty pharmacy prescriptions, understanding how each stakeholder uses and values the different data elements will facilitate the improvement of patient outcomes while managing health care expenses. Successful companies will provide cost-effective services while utilizing data to document and prove their impact on patient outcomes and expenditures.

About the Author

Ann Johnson, PharmD, is a consultant with Pharmacy Healthcare Solutions, Inc, which provides pharmacy consulting solutions in a variety of areas including, but not limited to, product and program development, business strategy, market research, operational efficiency, claimsdata analysis, and training program construction. Dr. Johnson specializes in market research and claims-data analysis. She can be reached at ajohnson@phsirx.com.