When considering whether to build or accelerate a specialty pharmacy service, many health system and pharmacy leaders question if health plans and drug manufacturers will provide the specialty pharmacy network access needed for success.
In our experience, we have found that – with the right approach and persistence – health systems can gain specialty pharmacy network access. This is because those offering clinic-based specialty pharmacy services directly support the goals of health plans and drug manufacturers: ensuring appropriate use, rapidly initiating therapy, enhancing patient outcomes, and lowering the overall cost of care.
Among other healthcare trends, value-based care, risk-based contracts, and expensive specialty therapies make developing strong partnerships with health plans and drug manufacturers increasingly important for provider organizations. So what do health system and pharmacy leaders need to do to gain access for their specialty pharmacy programs?
Recognize how your specialty pharmacy program’s unique attributes benefit health plans and manufacturers
Your health system must be able to articulate how offering integrated specialty pharmacy services benefits all stakeholders, including health plans and manufacturers, by working to ensure:
- Physicians prescribe the most appropriate specialty medications,
- Patients can access specialty medications quickly and conveniently,
- Patients can take or use medications as directed, with strong personalized support,
- Specialty medication therapies achieve desired clinical outcomes, and
- Patients and providers have an excellent specialty medication experience.
Fully clinic-based health system specialty pharmacy programs are able to drive these results because of key attributes that distinguish them from other models, like call-center programs or contract and mail-order pharmacies:
- Access to data. Because health system specialty pharmacies can combine dispensing data with patients’ medical records, they are uniquely positioned to measure and report on both short-term and longitudinal outcomes. Access to broader data sources allows health system specialty pharmacy teams to monitor patient adherence and track the efficacy of specialty medications. It also enables them to report on other clinical end points, such as quality of life, readmissions, and ED visits. Additionally, health systems regularly participate in clinical research and report on quality measures. With these capabilities, health system specialty pharmacies can improve patient care by developing standardized quality benchmarks that can be used across organizations.
- Full continuum of care. Unlike external specialty pharmacies, health system specialty pharmacies can support patients across the full continuum of care. Because clinic-based specialty pharmacy associates work directly alongside doctors, nurses, and other care team members, providers can easily coordinate information and decision-making. This helps improve quality of care while lowering costs. Providing comprehensive care also enables health systems to streamline the patient experience. When patients fill specialty medications through health system-owned specialty pharmacies, providers can better monitor adherence. If patients don’t pick-up or refill their prescriptions, specialty pharmacy team members can proactively reach out to patients and communicate with other providers too. This can eliminate gaps in care and prevent avoidable medical events.
- Personalized support. Clinic-based pharmacists and pharmacy liaisons regularly interact face-to-face with patients. As a result, they get to know patients personally and can provide support based on patients’ unique needs. Additionally, when patients have questions about their therapy, they feel comfortable calling a specialty pharmacy team member they personally know. This helps address barriers to treatment, ensuring patients start therapy sooner and stay on it over time.
Develop a plan to gain health plan and manufacturer specialty pharmacy network access
Gaining access – especially to payors – takes effort and expertise as well as a long-term mindset. To prepare to engage with health plans and drug manufacturers, health systems must:
- Operationalize a specialty pharmacy program. Though starting a specialty pharmacy program may seem like an obvious first step, this is often more complex and time-consuming than health system and pharmacy leaders anticipate. Scaling a program is a complex undertaking that demands organizational and pharmacy capabilities. Among other requirements, a health system must identify a specialty pharmacy technology solution that integrates with its EHR to support patient identification and management and collect necessary data.
- Collect and analyze data to demonstrate outcomes improvements. Baseline and post-implementation data will be needed to evaluate the impact of the program, demonstrate outcomes improvement, and build a road-map to guide ongoing program enhancements. For this reason, a health system should begin collecting and analyzing data even before launching its specialty pharmacy program.
- Develop a targeted access plan. Once the program can show improvements in quality and cost of care, health systems are in a strong position to begin seeking access from health plans and manufacturers. We recommend collaborating with your managed care team to build a data-driven strategy to determine which health plans and manufacturers to target first.
For more insights on how your health system can overcome barriers to specialty pharmacy success, watch our recent Becker’s Hospital Review webinar.
Contact Trellis Rx to learn more about our success helping health systems grow clinic-based specialty pharmacy programs and secure access to health plans and drug manufacturers.