The importance of patients, providers, clinical staff, payors and pharmaceutical manufacturers
Specialty pharmacy is a rapidly growing segment of drug spend, projected to comprise $250 billion in revenues by 2020. Hospitals and health systems are feeling the pressure to build or expand existing specialty pharmacy services in order to compete for patients with chronic complex diseases who require specialty medications.
Because hospitals and health systems are uniquely aligned to deliver the care that these patients need, every hospital should have a specialty pharmacy strategy. That strategy must recognize the impact each key stakeholder will have on the success of the specialty pharmacy, including patients, providers, clinical staff, payors and pharmaceutical manufacturers and how to develop and manage those relationships for success.
Patients can be overwhelmed by their complex medication regimens, potential drug side effects, and concerns over the cost of their drugs. Not addressing their concerns can lead to non-adherence. An innovative model created by
the University of North Carolina Medical Center was able to improve adherence rates by providing the following support to patients:
-Patient education regarding treatment and side effects before and during treatment
-Adherence monitoring using patient surveys
-Adverse effect management to address side effects
In addition, to help with patient drug co-pays, take a look at patient assistance programs offered by pharmaceutical companies. Eligible patients can utilize manufacturer copy discount programs or patient assistance programs to lower out-of-pocket costs for their specialty medications.
Communication is often fragmented in the healthcare environment where the fax machine and landlines are still used to communicate and coordinate care. A landmark study by Biologics found that the average cancer patient saw more than 13 different healthcare providers within a one-year period. With all those moving parts, it is essential to keep providers in the loop regarding their patients who are being treated for chronic complex conditions.
Providers want to know that their patients are receiving excellent care and that they will be informed regarding that care and any issues that may arise. Technology is improving information flow through electronic health records and health information exchanges. Healthcare technology startups are creating secure messaging platforms that are HIPAA compliant and enable care teams to communicate with each other. Keeping providers in the communication loop will be increasingly critical as specialty pharmacy services continue to grow.
Clinical staff are being tasked with even more work in the specialty pharmacy space. Traditionally, an oncology nurse already bears a heavy load of responsibilities, including:
-Review patients’ health history
-Track laboratory, pathology and imaging studies
-Communicate with physicians on patients’ behalf
-Safely administering medications, fluids and cancer treatments
-Help patients plan and manage symptoms throughout treatment
-Translate complex medical terminology and answer questions
However, as specialty pharmacy exponentially increases in importance, oncology nurses also need to be prepared to include educating patients on their specialty pharmacy choices, completing prior authorization paperwork and liaising between specialty pharmacy and hospital or clinic.
Pharmacists who are integrated into clinical roles can help reduce the burden on already overworked clinical staff. A specialty care model developed at Vanderbilt University Medical Center inserts pharmacists directly into the comprehensive management of patients on specialty medications. Not only does the Vanderbilt model reduce the demands on clinical staff, it also ensures patient adherence and coordinates care and collaboration with providers through the use of electronic medical records.
HOW TO MAKE A HOSPITAL SPECIALTY PHARMACY ATTRACTIVE TO PAYORS:
-Invest in IT and data analytics in order to track and report data and outcomes as required by payors
-Achieve accreditation from two of these accrediting bodies
-Utilization Review Accreditation Commission (URAC)
-Accreditation Commission for Healthcare (ACHC)
-Center for Pharmacy Practice Accreditation (CPPA)
Payors are continually looking to better manage their drug spend as medication costs continue to rise and are tightening networks. They expect detailed tracking and reporting of financial, clinical, quality of life, and patient satisfaction scores. Payors are invested in reducing the total cost of care and seeing value for patient treatments.
URAC is considered the “gold standard” of accreditation for specialty pharmacy and covers drug-drug interactions, call center performance, dispensing accuracy, distribution accuracy and prescription turnaround time. In the era of value-based care, pharmacies must show how their clinical services are impacting clinical, financial, quality of life and patient satisfaction measures. Accreditation ensures compliance with healthcare’s most comprehensive and rigorous standards, requiring specialty pharmacies to continually measure, monitor and evaluate the services they provide. Importantly, patients directly benefit from this accountability.
Specialty drug manufacturers often restrict access to certain specialty drugs. While each manufacturer has different clinical and reporting requirements, several factors can help a specialty pharmacy secure limited distribution drug contracts:
-Clinical expertise from a knowledgeable care team that manages relationships between patients, caregivers, prescribers and payors
-Technology to track and report financial, operational and clinical outcomes
-Systems in place for medication handling, dispensing and monitoring requirements
-Clinical support for specialty diseases or specific patient populations
-Access to payor contracts
Pharmacies that can demonstrate expertise in specific patient populations or disease states may have an advantage. Having care coordinators, nurses and pharmacists in place who are trained in specific diseases demonstrates to manufacturers that the specialty pharmacy may be a good fit for access to the limited distribution drug. Additionally, providing excellent services to patients taking open distribution drugs can show the manufacturer that the organization is well aligned to take on a limited distribution drug.
In order to be successful in the specialty drug world, pharmacies must understand and meet the needs of these five stakeholders. CPS SPARX can help your organization create a winning specialty pharmacy strategy that addresses the challenges that these stakeholders present and position your overall organization for success in the specialty pharmacy space.
For more information on how the CPS SPARX team can unleash the powerful potential inside your organization, visit cpssparx.com.
This post is related to:Specialty Pharmacy