As the number of specialty drugs has grown in the past decade, regional health systems and academic medical centers have stepped up to assert the power of integration and coordinated care by establishing and expanding their own specialty pharmacies.

The guiding premise of an integrated delivery network (IDN)–based specialty pharmacy is that the patient must be at the center of care. With an IDN infrastructure, all members of the care team are empowered to rally around the patient. They can coordinate information and decision making to balance 2 important objectives: delivering the best possible care and managing the cost of care.

At Banner Health, in Phoenix, Arizona, we recognized that we had all the ingredients to provide great care, but we needed to add a specialty pharmacy component to improve care for patients with complex needs. In 2014, we built an in-house specialty pharmacy in 6 months, launching in October of that year.

In addition to the typical features and capabilities, such as a call center, patient educational providers, data reporting, express shipping and tracking, and cold chain expertise, an IDN-based specialty pharmacy involves some not-so-typical capabilities. For example, pharmacy liaisons are embedded in specialty clinics to reduce the administrative burden on clinic staff and assist patients on the spot. Smoother workflows, shorter time to first fill, and greater patient satisfaction result from this operational model.

Another way we exceed minimum standards is by offering same-day order fulfillment and delivery in our service area. We also offer regional patients the flexibility to receive drug therapy at the right site, whether that is at home, at the clinic, or at an infusion center.

Building the Banner Health specialty pharmacy would not have happened so quickly without Excelera, a member-owned network of health systems that focuses on optimizing care for patients with complex needs through specialty pharmacy collaboration. Excelera’s assistance helped us build the specialty pharmacy to meet rigorous standards in the areas of compliance and accreditation, operational capabilities, benefits and assistance, clinical and adherence programs, performance metrics, and data reporting.

The notion of a specialty pharmacy net- work was simply an innovative idea in 2009 when Excelera was formed, a collaborative venture that would set operational standards, find ways to facilitate pharmacy data collection, and assist health systems in building their own specialty pharmacies. The network model was created in response to 3 major challenges: payer lockout, lack of access to some specialty drugs, and significant gaps in the ability of IDNs to address manufacturers’ complex data needs. Only by addressing these challenges and providing integrated, coordinated pharmacy care to patients with complex and chronic conditions can health systems achieve the Institute for Healthcare Improvement Triple Aim: improving population health, improving their patients’ care experience, and reducing the per capita cost of care.

PATIENT CARE AT THE CORE

Without specialty pharmacy access at the point of care, patients can face hurdles that range from inconvenient to dangerous. Two examples from Excelera members:

• A patient who had undergone a kidney transplant stopped taking medication for 1 month because his outside pharmacy failed to correctly handle a transition from Medicare to Medicaid. With the IDN model, a refill follow-up phone call might have caught the issue sooner, sparing the patient hospitalization for rejection and treatment with thymoglobulin.
• A patient with breast cancer had no choice but to obtain 2 different oral oncolytic drugs from 2 separate outside specialty pharmacies because of payer restrictions. She could have had a seamless transition from clinic to home if the Excelera member where she was a patient had been authorized by the payer to fill the prescriptions (as a National Cancer Institute–designated Cancer Center, the member had access to both drugs).
• Since the concept of the Excelera network took shape, the specialty pharmacy landscape has become only more complex and costly. This year, specialty drugs will likely account for half of overall drug spending.1

Given these circumstances, the importance of an integrated specialty pharmacy is thrown into sharp relief. Countless examples demonstrate the efficacy of the IDN-based approach to improve outcomes and control costs. It is very common that patients who require specialty medications must use multiple pharmacies. This presents unique challenges in managing adherence, drug–drug interactions, and overall care coordination. However, through the work of integrated health system specialty pharmacies, these issues can be addressed through read-and-write access to the patient’s electronic health record. The clinical pharmacists, from the vantage point of the pharmacy, can bring providers from multiple specialties together to coordinate the development of a care plan. This is how the care of patients with complex needs should work, and IDN-based specialty pharmacy makes the process possible.

AGGREGATION, ACCESS, EFFICIENCIES

Every health system has unique strengths and a unique culture and serves a certain geographical region, but these qualities have not served them well in accessing limited distribution drugs (LDDs). In 2012, Excelera addressed a significant barrier to drug access by completing a proprietary data reporting system that provides a single source for accurate and reliable data collection and transmission to manufacturers, who can now rely on consistent data from all health systems in the network. The data reporting provides a clear, seamless picture of what is happening at the point of care, allowing manufacturers to view health systems as viable elements of their national strategy.

For manufacturers, an advantage of the network concept is that it offers the opportunity to execute a national IDN strategy by contracting with 1 organization to access their target IDNs rather than having multiple conversations and executing contracts with multiple IDNs. With the aggregation of patients, data, and contracting, the network model creates efficiencies that make working with IDNs attractive for manufacturers.

On behalf of its members, the network can respond to manufacturer request for proposals for LDDs and be a legitimate contender. For clinical trials onward and throughout a medication’s market lifecycle, health systems in the network are an ideal home for LDDs. Specialist physicians at IDNs have access to patients to participate in clinical trials. When health systems participating in trials continue to have access to drugs even after these drugs go to market, patients are spared the problems that can result if they must begin filling their prescriptions through outside pharmacies.

CONCLUSION

For patient care, the logic of recognizing health systems as the most effective choice for specialty drug distribution is indisputable. With the collaborative power of a network behind them, health systems have the size, data, and operational capabilities to live up to manufacturer requirements.

Reference

1. Singhal, Shubham. Pharma spending growth: Making the most of our dollars. McKinsey & Company, 2017.