As chronic illnesses have become more prevalent in the United States, specialty medications to manage these conditions have flourished. According to a recent IQVIA report, a staggering 65 percent of the new drugs that came to market in 2018 were specialty drugs.1 These therapies can improve care and outcomes, but many patients struggle to start and stay on them for reasons including affordability, healthcare access, and socioeconomic factors.
Health system specialty pharmacies can address barriers to medication access and adherence. Increasingly, hospitals are offering clinic-based specialty pharmacy services to provide high-touch, personalized care to patients with chronic and complex illnesses. This approach leads to better patient care and outcomes, while enabling safety-net providers to make more comprehensive services available to low-income patients.
Affordability is a leading barrier to specialty medication access and adherence
Affordability is a top reason patients fail to start and stay on specialty therapies. Though the average copay for a specialty prescription is $99, annual out-of-pocket costs can be significantly higher for patients with chronic and complex conditions.2 The Kaiser Family Foundation found that individuals covered under Medicare Part D in 2019 face out-of-pocket costs ranging from $2,622 to $16,551 for hepatitis C and leukemia specialty medications respectively.2
Unsurprisingly, high costs keep many patients from taking drugs as prescribed. This challenge is greatest for the 30 million uninsured Americans.3 In 2018, uninsured Americans were three times more likely than adults with private coverage to delay or skip a prescription because they couldn’t afford it.4 Unfortunately, as the number of uninsured Americans continues to grow, this challenge is only becoming more acute.5
Yet having insurance does not guarantee the ability to afford specialty drugs. In a 2016 survey, one-third of Americans without continuous insurance coverage and 14 percent of insured Americans reported skipping doses or not filling a prescription due to costs.5 The situation is even worse for patients with chronic conditions. In the same survey, one in four American adults with chronic illnesses reported skipping medications because of costs.5
Socioeconomic factors also affect patients’ ability to access specialty drugs
Other obstacles also make it difficult for patients to get specialty medications. These barriers include education, language, and socioeconomic factors such as low income, food or housing insecurity, and limited vehicle access. In fact, a recent study found that prescriptions for children from zip codes with high poverty rates and low vehicle access are significantly less likely to be filled.6
Inability to access healthcare is another challenge that causes many patients not to start or stay on specialty therapy. Increasingly, hospitals in rural communities are filing for bankruptcy, creating “health hazard zones.” Patients in these areas are left with limited access to doctors, especially specialists who can prescribe and help them manage specialty medications.
Clinic-based health system specialty pharmacies offer a solution to access challenges
Clinic-based health system specialty pharmacies are improving access and adherence to specialty medications by addressing these barriers. Unlike external specialty pharmacies that rely on strangers in remote call centers, fully integrated specialty pharmacies provide the high-touch, personalized care patients need to start and stay on specialty drugs.
Clinic-based programs are centered on direct pharmacist-to-patient engagement. This model embeds pharmacists directly alongside doctors and nurses to provide in-person education and ongoing support to patients requiring specialty medications. Pharmacy liaisons also work in specialty clinics to manage prior authorizations, refill reminders, prescription deliveries, and more.
One way clinic-based specialty pharmacies improve access for patients is by securing financial assistance from pharmaceutical companies, patient groups, and other organizations. At Southern Ohio Medical Center, a 222 bed hospital located 85 miles from a major city, these efforts helped lower the average patient copay to just $0.38.7 One patient wrote a thank-you note to her pharmacy liaison, saying “You can never know how grateful I am for what you’ve done for me. I would pretty much be bankrupt if I had to pay for these drugs if it weren’t for you.”
Specialty pharmacy team members also improve access by connecting patients with other social services to address socioeconomic barriers such as homelessness, lack of food, and lack of transportation. Because clinical pharmacists and specialty pharmacy liaisons work on-site, they can easily collaborate with the hospital’s case managers and social workers to connect patients with needed social services.
In addition to improving medication access, research has found that clinic-based specialty pharmacies drive better time-to-therapy and higher therapy completion rates compared to other approaches. Getting patients on therapy sooner and keeping them on it longer is key to enhancing health outcomes, which can improve patient satisfaction and reduce the overall cost of care.
Specialty pharmacy programs allow 340B health systems to extend care to more patients
In addition to improving patient care and outcomes, offering specialty pharmacy services enables health systems participating in the 340B drug pricing program to extend care to more vulnerable patients.
The purpose of the 340B drug pricing program is to allow participating safety-new providers to “stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.”9 Participating organizations purchase outpatient drugs from pharmaceutical manufacturers at a discounted rate and use the savings to enhance care and outcomes for underserved patients.
340B hospitals and clinics can significantly increase their savings by bringing specialty pharmacy services in-house. Examples of how health systems invest their savings include starting meds-to-beds programs, offering patient assistance funds, or opening HIV and hepatitis C clinics.
Ultimately, clinic-based health system specialty pharmacies help patients overcome common barriers to specialty medication access to drive improved patient outcomes and better medication adherence, while increasing revenue opportunities for the health system. Watch this short video from Southern Ohio Medical Center to see the positive impact an in-house specialty pharmacy program can have on your community.
Ted Slafsky M.P.P. serves as a policy advisor to Trellis Rx. He is one of the nation’s leading experts on health care policy and access, pharmaceutical pricing and the hospital industry. Based in Washington, D.C., Mr. Slafsky is founder and principal of Wexford Solutions where he consults with businesses and non-profits looking to strengthen their position in the marketplace and improve health care outcomes. Previously, he served as President and Chief Executive Officer of 340B Health, an association of close to 1,400 hospitals participating in the 340B drug discount program.
- Based on average copay for patients using Southern Ohio Medical Center Specialty Pharmacy in April 2019