In today's evolving health care and reimbursement landscape, specialty pharmacies are facing pressure to adopt more efficient and cost-effective solutions. AscellaHealth, a pharmacy benefit management (PBM) services company, is tackling many of the known challenges through an innovative, tailor-based approach.

“[AscellaHealth] sort of cut its teeth early on in the long-term care arena and still has a substantial presence there,” Dea Belazi, PharmD, MPH, president and chief executive officer, said in an interview with Specialty Pharmacy Times®.

In addition to being rooted in the long-term care setting, the company has evolved over the last few years, branching into different areas of health care.

“[AscellaHealth] is partly [involved] in the traditional PBM services, but [is] really focused as a solutions provider for a range of different customers around what we call ‘specialty pharmacy carve-outs,’” Belazi explained.

AscellaHealth’s more individualized approach is what differentiates its programs from many other PBMs, and this includes the specialty pharmacy carve-outs. Clients can choose from full-service PBM administration or a tailored stand-alone option. This approach offers a wide array of services, which include specialty drug management, formulary management, and clinical services, “whether that’s taking on an entire specialty pharmacy benefit, for employers, health plans, and other customer market segments, or taking that entirely to certain diseases,” he said.

From an innovative perspective, AscellaHealth’s specialty pharmacy carve-out program helps pharmacies adjust to the challenging cost trends by identifying better solutions. With specialty drug costs increasing in market share, the carve-out program seeks to improve outcomes and care coordination while managing drug spend.

“In [specialty pharmacies], at the end of the day, their reimbursement is purely and strictly involved with fulfillment, but they offer a lot of clinical services, other services, etc, that they either don’t get recognized for or don’t get compensated for,” he explained.

By partnering with specialty pharmacies, AscellaHealth assesses the full scope of offerings at each pharmacy and provides a competitive reimbursement model that takes these additional services into account.

“And I think that’s where we want to work with the specialty pharmacies togeth- er and say, ‘Hey, here’s how this needs to look, and here’s our ability to measure performance beyond cost and to make sure this is working well,’” Belazi said.

In addition, AscellaHealth’s limited-distribution specialty pharmacy program can help those who have traditional specialty pharmacy capabilities but may lack access to this subset of products.

“That’s a network we offer to many of our hospital, health-system, and long-term care clients who might have their own specialty pharmacies that just need to be able to fill those gaps,” Belazi said.

Programs focused on specific specialty concentrated disease states are another way AscellaHealth helps pharmacies manage their drug spend. According to Belazi, these programs allow the pharmacies to provide A-to-Z solutions for these customer segments. He used AscellaHealth’s hemophilia-focused program as an example of this.

“Customers can come to us, or clients can come to us, and say, ‘we’re only interested in managing this hemophilia spend. We have 10 hemophiliacs, it’s really expensive, and we’re just looking for a better way to do this,’” Belazi said. “That’s where we come in and offer a better, more efficient, cost-effective model to do that.”

Other programs focus on hereditary angioedema and dermatology, such as psoriasis, for which treatments are
especially costly.

“We have a really great specialty pharmacy network that’s competitive on price that offers a lot of good clinical services that complement what we do,” Belazi noted.

This is all done in a partnership with their expansive network to provide the most effective services to their clients. Looking ahead, Belazi said AscellaHealth’s goal is to search for other opportunities for its customers while facing the challenges of specialty pharmacy head on.

“I think this is part of what our refine- ment model is going to continue to look like in that every month or quarter or year that goes by we’re hoping to do this better, faster, and cheaper, and offer a really good solution,” Belazi said.