Coming Out Party: Outcomes in Specialty Pharmacy
Specialty pharmacy providers are uniquely positioned to capture information on a wide array of outcomes.
Information collection and interpretation is now firmly entrenched as a necessary aspect of any specialty pharmacy provider. Enormous quantities of data can be purchased and deconstructed to determine the strengths and weaknesses of the pharmacy’s current standing in the industry.
Analysis of market data is all but required by these firms in order to adequately maintain their current standing. These standardized sets of information serve as a rearview mirror of sorts—allowing for evaluation of the cause-and-effect relationship of earlier strategies.
However, data can be captured and leveraged proactively. In addition to the methods described above, specialty pharmacy providers are uniquely positioned to capture information on a wide array of outcomes.
The ability to demonstrate superiority is no longer a luxury, as the number of specialty pharmacy providers has grown exponentially. Similar to wins and losses in professional sports, outcomes data is rapidly becoming the scorecard for the practice of specialty pharmacy.
Whether it’s patients, manufactures, or insurers, the ability to effectively capture and convey effective outcomes management can be the difference between playing in the big leagues and being stuck in the minors.
Clinical Outcomes: The Hokey Pokey?
While markedly different than the children’s song and dance, patient outcomes are truly what it’s all about. After all, specialty pharmacy providers evolved from the need to provide high-touch services to critically ill patients with complex disease states.
Successful aggregation of patient-centric outcomes data is crucial to specialty pharmacy provider operations. Overall, the primary goal is to demonstrate a positive clinical response to therapy.
Clinical response has both quantitative and qualitative measures that bear equal importance in telling the complete patient tale. Quantitative measures will obviously vary based on the disease state, and will likely mirror the clinical measures observed during clinical trials.
This ability to track changes in standardized values is now essential to obtaining access to products, as manufacturers often contractually require this information to be passed back.
In addition to required documentation, specialty pharmacy providers can benefit from obtaining subjective, patient reported outcomes (PRO)1.
Though difficult to standardize, recording patient reported outcomes can create a unique opportunity. The number of registered specialty pharmacies has grown exponentially, with providers homogenizing their credentials and services offered. The ability to provide qualitative data—improvement in quality-of-life or satisfaction with drug therapy—could potentially distinguish one SPP from another in the increasingly competitive market.
Access to specialty medications is contingent upon a contractual relationship—one dictated by the pharmaceutical company. As more specialty pharmacy providers enter the market, manufacturers are able to require increasingly more services and guarantees from its network providers, and still manage to provide universal access to its products.
While some requirements, such as 24/7 access to a licensed pharmacist, are based on logistics, the industry is slowly migrating toward patient service guarantees. As the industry struggles to develop a standardized benchmarking system, some service metrics are now integrated into request for proposals. Call center metrics, such as average speed-to-answer and call abandonment rate, are implemented to assure satisfactory patient contact.
Adherence metrics2 are also in style, as medication distribution is the primary function of any pharmacy. Proportion of days covered is now emerging as the preferred measure of adherence, though it merely measures medication possession. Manufacturers are not the only stakeholders interested in pharmacy performance, as payers are beginning to investigate tying reimbursement to outcomes.
Payer Outcomes: Looking Past the Stars
Medicare Star Ratings3 are the first wide-spread attempt to financially reward the best performing health care providers. Pharmacies are measured by the aggregate of their patients, and currently, the disease states addressed have a minimal footprint in the specialty space. However, the exploding costs of specialty therapies is fostering an environment in which guaranteed outcomes are required to justify the high cost of therapy.
Whether it’s the cure rate for hepatitis C, the hospitalization rate for multiple sclerosis, or a currently unthinkable and quasi-miraculous outcome from a future therapy, third party payers are eventually going to consider requiring specialty pharmacy providers to share in the financial risk associated with treatment failures.
Though it is difficult to hypothesize the terms of such an agreement, a specialty pharmacy provider must excel at clinical patient management and robust documentation thereof.
Assuring a Place in the Big Leagues
Once an adjunct to medical care, drug therapies are increasingly the cornerstone of successful disease state management. Many of these previously untreatable disease states are now mediated with innovative, complex therapies—with a price tag to match the therapeutic breakthrough.
This reality has attracted more and more players who want a piece of this huge revenue pie, and transformed specialty pharmacy from a niche segment to a highly competitive channel. With so many entities vying for business, a specialty pharmacy provider’s ability to generate and document the best possible patient outcomes is crucial to thriving in the industry.
While patient outcomes, are the primary focus, success in this space potentiates the reputation of the pharmacy to all other stakeholders in the delivery dynamic.
About the Author
Christopher Ogurchak earned his PharmD degree from the Duquesne University in 2011. Chris served as a pharmacy manager at an independent pharmacy in Southwestern Pennsylvania before transitioning to CVS Specialty Pharmacy as a clinical pharmacist. He is currently enrolled in the Masters of Science in Pharmacy Business Administration (MSPBA) program at the University of Pittsburgh, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines.