All About Health System Pharmacies


A look into the differences between specialty pharmacies in integrated delivery networks and academic medical centers.

A session at the National Association of Specialty Pharmacy Annual Meeting and Educational Conference compared 2 different types of pharmacies: an integrated delivery network (IDN) specialty pharmacy and an academic medical center.

It is important for pharmacists and other stakeholders to understand the difference between specialty pharmacies in various settings, as their practices and challenges differ significantly.

Tammy Pierce, BS Pharm, RPh, director of Pharmacy Services at Credena Health, discussed the specialty pharmacy for Providence St Joseph Health, the third largest non-profit IDN in the country.

Pierce said that the specialty pharmacy dispenses more than 1000 prescriptions per day and is licensed in 45 states. This pharmacy serves 1.4 million patients through several public and private insurance plans.

In some health systems, providers are able to send prescriptions to multiple specialty pharmacies based on who has access to the drug along with other factors, which can result in varied outcomes and additional challenges. The integration of a specialty pharmacy closes the loop to ensure patients are receiving the best quality of care.

“The patient is able to utilize the global resources within the organization to receive an expert level of clinical services,” Pierce said during the session.

Additionally, the specialty pharmacy is able to collaborate with the health system’s electronic medical record system (EMR), which can close gaps in care and prevent potentially harmful medication errors.

Pierce also said that a patient-centered, mission-focused, and clinically integrated system provides value to payers and plan sponsors.

Lonnie Smith, PharmD, FAST, manager of Specialty Pharmacy Services at University of Utah Health discussed the differences of a specialty pharmacy at an academic medical center. Smith said that they focus on providing the best patient experience through personalized support, coordination of clinical services, and being a single point of contact.

This specialty pharmacy also provides mail-order services to multiple other states besides Utah, as well as courier services, according to Smith. He added that pharmacists are always working with health care providers to further integrate care.

As an IDN specialty pharmacy, Credena focuses on serving lower income and vulnerable patients, which may not be the mission of some independents, according to Pierce. Another difference is the access to EMR data to improve patient care.

Pierce said that these specialty pharmacies may face significant challenges when a patient requires a drug that they do not have access to or if they are out of network for a certain payer.

Additionally, moderator Bill Roth, founding partner at the Blue Fin Group, discussed how certain IDNs may partner with manufacturers to help bring a specialty drug to market, but then may not have access to it post-approval.

Pierce mirrored those frustrations, but said Credena partners with providers and has seen success. Smith said that it can be challenging when pharmacists and providers help develop a drug and then get shut out of distribution. He said that the University of Utah Health has approached the situation similarly to Credena, which was successful.

The panel also discussed how when looking for contract pharmacies, the patient is the main part of the conversation.

Both Pierce and Smith agreed that there are no limits to what their pharmacists would do for their patients, regardless of the type of specialty pharmacy. From the moment the prescription is received, there is a care team taking care of the patient’s claim, running insurance verification, and ensuring they get access and remain adherent to therapy.

“We do this hundreds of times a day,” Smith said. “It’s what we do and that’s one of the reasons why I stay in the academic health system. There is really nothing we wouldn’t do to try to gain access to a medication for a patient in need.”

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