36 Operations & Management
Pharmacy Practice News • August 2022
Practice Trends
Survey Showcases Health-System Specialty Care By Karen Blum
Phoenix—Health-system specialty pharmacies (HSSPs) have developed robust patient care services 30,001-45,000, that encompass the patient journey from before spe16% cialty medication selection through treatment mon340B-covered itoring and optimization, according to results of entity, 99% the 2022 ASHP National Survey of Health-System Specialty Pharmacy Practice. >45,000, 30% Survey results, presented at the 2022 ASHP Summer Meetings and Exhibition, also found that HSSPs col10,001-30,000, Have offered 20% lect and use patient outcomes to drive monitoring specialty pharmacy and interventions, and that HSSP pharmacists and services for technicians integrated into specialty clinics serve as <5,000, 20% 7+ years, 48% a valuable clinical and educational resource for other clinic staff. 5,001-10,000, 0 00 However, there is room for improvement for HSSPs 12% in areas such as communicating outcomes metrics with stakeholders, using collaborative prescribing agreements and contributing to scientific literature, Affiliated with an said Autumn Zuckerman, PharmD, AAHIVP, BCPS, Figure 2. Prescription volume. academic medical CSP, the director of health outcomes and research at center, 64% Vanderbilt Specialty Pharmacy, in Nashville, Tenn. The survey, developed by ASHP and the Vanderbilt Health System Specialty Pharmacy Outcomes Research Unsure, ure, >$20 Consortium, involving 26 health systems, built on 10% % million, ASHP’s first national survey on health-system spe14% Not cialty pharmacy practice from 2020 (Am J Health Syst tracked, racked, Pharm 2021;78[19]:1765-1791), Dr. Zuckerman said. 7% Figure 1. Characteristics of This year’s survey was designed to demonstrate the $10 million<$1 survey respondents. $20 million, million, benefits of HSSPs by showcasing clinical services they 10% 7% provide, she said. It contained 119 questions in six domains: general capabilities, pretreatment, treatment $5 millioninitiation, treatment monitoring, continuity of care always review provider medication selection and alert $10 million, them with concerns, Dr. Zuckerman said. Other comservices, and education and research. 13% The online survey was open in March and April 2022, mon roles were discussing medication selection with $1 million-$5 million, and representatives from 127 organizations partici- providers or making therapy selection. 39% For pretreatment assessments, all respondents said pated, representing a wide range of practice sites and demographics based on such factors as 340B eligibility they use EHRs to assess patients’ baseline disease status, comorbidities and conditions, and current medand prescription volume (Figures 1 and 2). ication list and previous therapies taken, and 51% Following are some survey highlights: General capabilities. More than half of respon- said pharmacists actively coordinate with clinics and dents said they provide services such as prior authori- patients to complete pretreatment workup when Figure 3. Amount of funds zation (PA) completion and denial assistance, financial needed. Counseling patients before medication selecgained from financial assistance enrollment, and specialty medication selec- tion occurs occasionally, and when it does, it is usually assistance programs annually. tion or recommendations for all patients prescribed during an in-person provider visit. Treatment initiation. Nearly all respondents said specialty medications at their health system, regardless of where they fill their prescriptions. More than they use patient assistance programs, manufacturer Approximately 71% said a single negative response half also said they provide enhanced services such as copay and free drug programs, and disease state foun- or side effect in patients will trigger pharmacist interinjection training, transitions of care coordination and dation support to reduce patient financial burden vention, while 54% said a negative trend will trigger disease monitoring for patients who fill their prescrip- (Figure 3), with some respondents reporting fund col- pharmacist intervention. Standard clinic protocols lections in excess of $20 million, said Nicholas Gazda, and patient/disease factors were the most commonly tions at the HSSP. In other findings, at least 80% said they frequently PharmD, BCPS, CSP, the assistant director of phar- reported considerations to determine the frequency or always documented services such as process and macy at Cone Health, in Greensboro, N.C. of assessments, with medication adherence, duration Initial medication counseling most often is con- of therapy and patient complexity being the biggest status of insurance navigation and financial assistance procurement; patient response to therapy; initial ducted by telephone, 73% of respondents said, but determining factors. Telephone was the most common patient counseling notes; and medication reconcilia- some do this during separate clinic visits, provider method used for monitoring patients. tion results in electronic health records (EHRs) visi- visits or via video, Dr. Gazda said. Additionally, more Continuity of care. About 69% of HSSPs go beyond than 80% reported that pharmacists were involved traditional fulfillment to offer clinical services such as ble to providers and clinic staff, Dr. Zuckerman said. Collaborative practice agreements and collaborative in screening and/or counseling for recommended chronic disease therapy management, collaborating drug therapy management programs were uncommon immunizations. with other team members to help with social deterTreatment monitoring. About 79% said patients minants of health, being involved in preventive wellin HSSPs, with 47% saying they did not use them in any of their clinics. HSSPs were most likely to report receive one to 10 touch points during their first year, ness programs and more, said Melissa Ortega, PharmD, their financial performance, prescription volume and exclusive of refill assessments, Dr. Zuckerman said, FASHP, the system executive director of ambulatory other metrics to health-system leadership, followed by and 95% reported tracking disease-specific outcomes services at Wellforce, the parent of Tufts Medical health clinic providers and staff, but were much less in at least some patients. Most (92%) said they use Center, in Boston (Figure 5, page 38). likely to report metrics to patients. In addition, 22% reported managing Risk Evaluation disease-specific outcomes reporting to meet accrediPretreatment. Respondents reported that 63% of tation requirements, although many other uses were and Mitigation Strategies, or REMS, program medications the time, pharmacists embedded in specialty clinics cited (Figure 4, page 38). see SURVEY, page 38
