specialty edge

Leveraging Data to Gain a Specialty Edge

Hospitals and health systems continue to build and expand their own specialty pharmacies, and with good reason, according to several veterans of specialty rollouts.

Today, more than 75% of hospitals with at least 600 beds operate a specialty pharmacy, allowing them to directly prescribe patients critical medications for various chronic and often lifethreatening diseases such as multiple sclerosis, chronic hepatitis C and many cancers, according to data cited in Drug Channels (bit.ly/2GqhLbb).

An in-house specialty pharmacy provides many financial and clinical advantages over external specialty pharmacies for both patients and providers, noted Stephen Davis, PharmD, the director of health system strategy for Shields Health Solutions, in Stoughton, Mass. Simply put, Dr. Davis said, “you need to have access to the drug if you want to take care of the patient.”

Dr. Davis also acknowledged the significant roadblocks, time and effort needed to successfully launch a specialty pharmacy—particularly in the face of the market’s increasing vertical integration. Dr. Davis cited a number of consolidations, mergers and acquisitions among payors and pharmacy benefit managers (PBMs), which manage the prescription drug benefits on behalf of Medicare Part D drug plans, large employers and other payors.

Breaking into this challenging and dynamic market can be difficult. But Dr. Davis and other experts shared strategies for overcoming the obstacles and accessing commercial payor contracts and limited distribution drugs.

Dr. Davis first reiterated that hospitals are uniquely positioned to provide optimal care via an in-house specialty pharmacy. Filling a prescription before a patient leaves the hospital is not only convenient, but it is also likely to improve health outcomes. “You’re having a specialty pharmacist talk with you who knows you as well as anyone,” he said. “You have a hospital that knows you and knows the care you need.”

In some cases, a patient who is prescribed a specialty medication may not need it due to conflicting lab values,

intolerance, toxicity or nonadherence. Or they may have developed a health condition or started a new medication that contraindicates the drug—something a health system’s electronic health record (EHR), providers and pharmacists could catch in real time. “An outside specialty pharmacy wouldn’t know if the patient missed their scheduled appointment with their provider, or that they were currently admitted to the hospital or at home sick,” said Dr. Davis, noting that the pharmacy may still mail the prescription. “That’s one of the extra benefits of having a specialty pharmacy in the hospital.”

Among the benefits of such engagements and touch points, he noted, is the potential for achieving superior medication adherence, and the ability to meet several other practice challenges in specialty care (Pharmacy [Basel] 2019;7[4]:163).

None of those positive outcomes, however, can occur without a strong managed care strategy, the experts stressed. For example, insurance companies often will dictate that a prescription must go to an outside specialty pharmacy. So, a hospital-owned specialty pharmacy needs to be included in a PBM or payoraligned specialty pharmacy network to dispense prescriptions to patients who want to use their specialty pharmacy services. Securing that access requires demonstrating to payors and other managed care stakeholders an ability to outperform external specialty pharmacies clinically and financially.

Data analytics also is critical. Meghan Swarthout, PharmD, MBA, the division director of ambulatory and care transi-

tions pharmacy at The Johns Hopkins Health System, in Baltimore, encouraged a focus on outcomes collection, measurement, analysis and reporting. “The data is there in your EHR, and you need to be strategic,” she said. “Look at clinical outcomes and incorporate patient-reported outcomes, including things like missed days at work or loss of productivity, as well as economic outcomes.

“Don’t just present to payors a minimum amount of data requested,” Dr. Swarthout added. “Be proactive and anticipate their needs.”

For example, payors are looking for the lowest-cost site of care for administering medications, especially infusion and injectable products. Do these medications need to be administered in a hospital clinic? Often it is less expensive and more convenient to provide these services in a patient’s home. “If we can’t control everything about drug cost, think about where else to look to save dollars,” she said.

“A lot of this is about partnering with payors and not looking at payors as competition,” Dr. Swarthout added. “Finding connections at the regional and local level is your best bet.”

Access Is Key

A viable specialty pharmacy needs access to limited distribution drugs, or medications that the manufacturer designates to a restricted number of pharmacies Jacob Jolly, the director of strategy and market access at Vanderbilt University Medical Center, in Nashville, Tenn., shared strategies for obtaining that access. Again, it’s about showing value. “Consider your capabilities early on,” Mr. Jolly said. “They should be sufficient not only to deliver the value that your prospective partners expect but also provide you with the ability to demonstrate and communicate said value.” He noted that his pharmacy has developed a unique outcomes and research program to optimize the care model and assess its impact. Each clinical area serviced at Vanderbilt’s integrated specialty pharmacy has at least one dedicated clinical pharmacist and one certified pharmacy technician often embedded into the clinic. By implementing the integrated specialty pharmacy model, Vanderbilt has been able to reduce the amount of time it took for patients to start therapy from 24.5 to three days (J Drug Assess 2019;8[suppl 1]:29). The program was awarded the ASHP Best Practices Award at the 2019 Midyear Clinical Meeting, in Las Vegas.

At Johns Hopkins, the clinical pharmacists are also involved in the design and development of the specialty pharmacy medication regimen before the prescription is written. In the case of a patient with cystic fibrosis requiring inhaled antibiotics, for example, the pharmacist in the clinic will work proactively with the prescriber and patient to recommend an appropriate antibiotic with preferred coverage based on the patient’s insurance. The pharmacist will also provide patient education during the visit, and attempt to get the patient started on therapy that day.

“We started upstream,” Dr. Swarthout said. “We thought about the clinical appropriateness and safety, financial considerations, quality of life, which all helps in terms of medication selection and the efficiency and coordination of care downstream.”

—Lynne Peeples