An understanding of patient outcomes and specialty product performance depends on the proper collection and aggregation of data. 


The concept of a specialty pharmacy has evolved over the last 15 to 20 years. These pharmacies typically were developed for a long-term care or infusion environment. Essentially, these pharmacies recognized a new line of opportunity with the introduction of high-cost, highly managed products designed for complex therapies. These disease states, as we know, include but are not limited to hepatitis C, HIV, multiple sclerosis, rheumatoid arthritis, and oncology.

The specialty pharmacy, whether it is a payer-owned model or an independent model, must possess a number of capabilities and competencies in order to be considered this type of practitioner. These capabilities include a commitment for resources to do benefit investigation, copay assistance, clinical support, and the ability to aggregate and transmit data to all stakeholders, including the manufacturing community and the payer community which is the topic of this discussion. The ability to collect and aggregate data is a key component for success in specialty pharmacy. The level of the data that must be collected for the specialty product and patient goes well beyond the traditional transaction-based data set required for typical chronic medications. Examples of this higher level of data sets include status and sub-status of particular patient population, the collection of ICD-9 codes, the collection of reasons for discontinuation, and side effect profiles.

Specialty pharmacy (SP) collects a number of behavioral and demographic attributes from each patient in the pharmacy’s service. With this connection, the pharmacy is able to develop a behavioral and demographic profile of every patient in its service. SP has profiled many patients during the time that this model has been developing. Having hundreds of attributes tied to patients in a wide variety of disease states enables the pharmacy to identify the attributes that are likely to generate the best results for the patient as well as the data most valuable to the other stakeholders.

In addition to aggregating patient data, the pharmacy can aggregate patient and product performance data. Performance data include components such as tracking the lifetime value of a patient for a particular pharmacy and, ultimately, the payer and manufacturer. By mining patient performance data, a pharmacy can analyze the performance of a particular product as it relates to efficacy, safety profile, and value to the manufacturer and payer. All of the stakeholders benefit from the lessons derived from aggregated patient and pharmacy performance data.

Sometimes, the pharmacy will express concern about our sharing their data or what is learned from their data with other companies. This general concern has merit given the competitive pressures of the market today and the pressures of HIPAA legislation. It is very important that the concern be addressed in unambiguous and precise terms. No patientspecific data should ever be shared or exploited to the benefit of another company. Competitive advantages and privacy must be protected. Aggregating data cross pharmacy and only using data in the aggregate provides this protection while delivering tremendous, previously untapped value to marketing groups within the payer and manufacturer.

Learning from aggregate data is one of the most important benefits of working with a specialty pharmacy. The better the pharmacy is at exploiting the learning for the benefit of its stakeholders, the greater the value it provides to these entities. To ensure that the pharmacies’ competitive advantages are protected, it is critical that patient-specific data are protected by contracts, policies, processes, and systems. To ensure that pharmacies get the most out of their investment, it is also critical that the pharmacy can use aggregated data to deliver unique and otherwise unobtainable value to the manufacturers and the payers. In a mature industry, every stakeholder can benefit from learning derived from aggregated data. The key is to make sure the data are handled responsibly.

At the end of the day, the data that can be derived from specialty pharmacy are very valuable to the manufacturer for a few key reasons. First, it is a realtime data source for the product team to assess the performance of a particular product. The manufacturer can assess side effect profiles as well as which physicians are supporting the product and which are not.

The data are also valuable for the manufacturer to assess the performance of the pharmacies themselves, including data points such as time to fill and the ability of the pharmacy to deliver the data itself in a timely and accurate manner. The data are valuable to the payer to assess the performance of its specialty pharmacy network as well as trend its cost in these high-value disease states.

The ability to collect and aggregate the data is key for a pharmacy to participate in the specialty space. It is also provides the pharmacy a good avenue to generate revenue from the aggregated data it collects.


About the Author
Nick Calla, RPh, JD, is the vice president of industry relations for the Community Specialty Pharmacy Network (CSPN). He has responsibility for the development of the relationships with the manufacturer community. Prior to CSPN, Mr. Calla was vice president of trade relations for Walgreens Specialty Pharmacy. Prior to coming to Walgreens, Mr. Calla worked as director of clinical programs and network administration for Eckerd Health Services. He was also president and general manager of Oncology Pathways, a group purchase organization founded by the UPMC Cancer Center and Medmark Specialty Pharmacy. Mr. Calla has expertise in the area of compliance, disease management, intervention programs, and negotiations with providers for a network. He received his bachelor of pharmacy degree from the University of Pittsburgh and a juris doctorate from Duquesne University.