Research reveals health system & health plan misperceptions inhibit patient-centered specialty pharmacy partnerships

Published 05/27/2020
by Kathryn Edwards

Atlanta, GA, May 27, 2020 – Today, Trellis Rx, a technology-enabled specialty pharmacy services provider, published a qualitative study that offers new insight into why health system specialty pharmacies often struggle to partner with payors. The study found that misperceptions about health system specialty pharmacies’ capabilities, outcomes and pricing often pigeonhole them into being seen as expensive providers of a “commodity” services by payors. Additionally, the study revealed opportunities for leaders of both areas to successfully collaborate using specialty pharmacy services to enhance the value of these expensive medications for patients and other stakeholders.

“As cost and utilization of specialty medications continue to rise, health systems and health plans must collaborate to ensure value for all stakeholders,” says Andy Pulvermacher, Principal Consultant, Blue Fin Group, who authored the foreword of the report. “This first-of-its-kind research provides new insights to promote dialogue and foster partnership, and I have faith leaders in both sectors will use this information to move the needle towards better patient care.”

Interviews with health system and health plan pharmacy leaders revealed underlying misperceptions about how each believes the other prioritizes cost and outcomes. Though both are focused on improving patient care, the study found these misunderstandings create barriers preventing them from partnering on specialty pharmacy services and achieving this common goal. Barriers found in the study that inhibit successful partnership include:

  • Health system and health plan leaders view each other antagonistically, using language like “conflicting interests” to describe their relationship.
  • Most health plans do not recognize the potential value health system pharmacies can create for their business, their customers and their members.
  • Many health systems have not invested in the specialty pharmacy capabilities and infrastructure required to deliver value to health plans.

However, despite these barriers, the study found that nearly all respondents agreed collaboration is critical to address the rising cost of specialty medications and improve care for patients. Further, the research identified steps all leaders can take to create effective partnerships. The chief among them is breaking down existing siloes and working to better understand how to address one another’s challenges and needs.

“Based on my experience operating a health system specialty pharmacy, I can say firsthand that patients often receive the brunt of the aftermath created by the misconceptions health system and payors have of each other,” states Jerry Buller, Chief Pharmacy Officer, Trellis Rx. “This research allowed industry leaders to share their thoughts candidly, and I look forward to seeing leaders from both sides leverage these insights to work together to enhance patient care.”

The study included blinded interviews with 10 health system pharmacy leaders across the U.S. with experience of building a specialty pharmacy and 10 leaders at regional and national health plans covering specialty pharmacy care. In addition, nine industry experts contributed unblinded insights to further bolster the findings.

The research also provides health systems that are currently growing or planning to build an in-house specialty pharmacy with greater insight into how to do so in a way that will enable collaboration with payors. Leveraging this information during the decision-making process will fuel more successful partnerships and bring greater focus to high-quality, cost-effective patient care.

“I’m encouraged by the health systems and health plans who have overcome these barriers and established specialty pharmacy partnerships that benefit patients in their communities,” says Andy Maurer, CEO of Trellis Rx. “I am confident the insights shared in this report will allow more organizations to achieve the same success.”

Read the full report here.


About Trellis Rx

Trellis Rx works hand-in-hand with health systems to improve the medication therapy experience for their patients with chronic and specialty conditions. Working under the health system’s brand, Trellis Rx provides medically-integrated pharmacy services that drive measurably better clinical and financial outcomes—faster—with less risk.

Trellis Rx’s unique clinical care model embeds highly skilled pharmacists and pharmacy liaisons directly into health system’s specialty clinics. Its fully integrated, local approach ensures patients with chronic and complex conditions receive the personalized, high-touch pharmacy care required to support adherence to treatment plans and improve clinical outcomes.

For more information, contact us.