A Candid Look at Barriers to Hospital and Payor Specialty Pharmacy Partnership

Published 06/19/2020
by Jerry Buller

Jerry Buller, Chief Pharmacy Officer at Trellis Rx

This commentary was featured in the 340B Report on 6/18. The article is part one of a two-part series on identifying and overcoming barriers to hospital payor specialty pharmacy partnerships.

For many 340B covered entities with an in-house specialty pharmacy, inability to gain payor specialty pharmacy network access prevents their health systems from extending specialty pharmacy services to more patients.

To uncover why, Trellis Rx recently commissioned a qualitative study with a third-party market research firm. This first of its kind study included blinded, in-depth interviews with 20 pharmacy leaders from health systems and health plans across the country, as well as unblinded expert interviews with industry thought leaders. The research allowed industry leaders to share their thoughts candidly and unfiltered.

Ultimately, we found that both stakeholder groups agree greater partnership is required to enhance the value of specialty medications for patients and their organizations. Yet, today they remain divided, talking past one another instead of determining how to work together to achieve their common goals.

Here are three of the barriers we identified:

Health system and health plan pharmacy leaders view each other antagonistically.

“Battle,” “hostile,” and “conflicting interests” were some of the terms participants used to describe the relationship between their organizations.

Unfortunately, these negative perceptions stand in the way of meaningful dialogue. The result?

A lack of understanding that leaves patients bearing the brunt of fragmented care. As one health system specialty pharmacy leader put it: “I don’t understand their picture of the world…many times I’m surprised because they don’t understand what we’re doing. We don’t talk—usually the patient is the ping-pong ball…”

Most health plans do not recognize the potential value health system pharmacies can deliver to their members, customers, and organizations.

Health plan participants largely viewed health system specialty pharmacies as expensive providers of a commodity service. They didn’t believe health systems had the economies of scale to offer the same pricing or services as national specialty pharmacies.

For example, many health plan leaders didn’t think health system specialty pharmacies were capable of providing 24/7 patient support or hiring specialty-trained pharmacists dedicated to specific patient populations. Most also didn’t believe health systems would negotiate on pricing.

In reality, many health system specialty pharmacies do have these capabilities. And the majority of health system pharmacy leaders interviewed indicated they are willing to negotiate on pricing in order to extend specialty pharmacy services to more patients.

Health plan pharmacy leaders also doubted health systems could deliver better results than other specialty pharmacies. As one pharmacy director at a national medical plan explained: “The only place where they could really show us additional value is in the outcomes, meaning patients are having better quality of life or lower health utilization costs. But I don’t know how they could possibly show this.”

Health systems struggle to demonstrate the value of their specialty pharmacy services.

Studies have shown that health system specialty pharmacies can improve clinical outcomes, operational performance, and patient satisfaction. However, many health systems lack the data analytics and reporting capabilities and infrastructure to prove their impact.

Most health systems also continue to track the same operational data points as national specialty pharmacies. Industry thought leaders agreed health systems must begin tracking disease-specific clinical endpoints and cost of care impacts to truly differentiate the value of their medically-integrated specialty pharmacy care model.

Industry thought leaders also advocated for collaboration across health systems to create benchmarks to evaluate health system specialty pharmacy performance.

Strategies to overcome barriers to payor & health system specialty pharmacy partnerships

The study also identified strategies health system and payor pharmacy leaders can leverage to drive patient-centered collaboration. Based on my experience leading a health system specialty pharmacy, I can say firsthand that health system and payor pharmacy leaders can leverage these strategies to overcome these barriers in favor of collaboration.

Ultimately, the organizations that recognize partnership as a strategic opportunity to enhance value for their members, patients and organizations will be the ones positioned to succeed in our changing healthcare landscape.

Learn about other steps health systems and payors can take to build mutually-beneficial specialty pharmacy partnerships by downloading our market research report. Subscribe to the 340B Report for our next installment focused on win-win collaborative strategies. You can also register for our Becker’s Hospital Review webinar on June 30 to hear about the study findings.