Evolving Technology, Data Capture Needs in Specialty Pharmacy
Pharmacy adjudication systems vary among specialty pharmacies and many limitations still exist across most providers in the market.
As specialty pharmacy continues to evolve, new technology is becoming more vital to ensure the successful management of increasingly sophisticated products, patients with growing needs, and a more difficult payer landscape. Particularly, patient management and comprehensive data capture needs are intensifying while many pharmacy management platforms try to keep up with the new requirements.
Many specialty pharmacies have implemented new external systems, while others have developed their own in-house solutions to meet these evolving needs.
Evolving Specialty Pharmacy Management Technology
Although electronic prescriptions are frequently utilized in the traditional pharmacy environment to seamlessly process and dispense medication, most electronic prescription platforms are not capable of capturing the data needed for approving and processing specialty pharmacy prescriptions. Additional information required in specialty pharmacy varies based on each disease state but may include, for example, patient weight, genetic test results, and other supporting information for these drugs to be approved and administered.
Due to the limitations within electronic prescribing platforms, most physicians resort to faxing prescriptions along with supporting clinical information to specialty pharmacies. This method is also preferred by many manufacturers, as the faxed image ensures that there is no risk of alteration by their specialty pharmacy. Once the prescription information is received, specialty pharmacies electronically transcribe the relevant information into their pharmacy adjudication and patient management systems.
Pharmacy adjudication systems vary among specialty pharmacies and many limitations still exist across most providers in the market. Although all of these systems are able to adjudicate claims, many are not able to meet all of advanced needs of specialty pharmacy products and patients.
Examples of more advanced specialty pharmacy adjudication platforms that incorporate more advanced patient management include WellSky’s CPR+ and their newly launched platform CareTend. CPR+ was originally based off of WellSky’s home infusion platform; however, it lacked some capabilities required for specialty pharmacies.
Specialty pharmacies using CPR+ in many cases used an advanced protocol interface (API) to integrate with other technology platforms, such as FedEx for shipment and TherigySTM for patient management to make up for these limitations. CareTend has recently been introduced by WellSky as a pure play specialty pharmacy system that fills many of the gaps presented by CPR+ and offers new capabilities such as medical billing.
ScriptMed, an entity headquartered in Pittsburgh, Pennsylvania, also offers a specialty pharmacy platform, ScriptMed Enterprise. This platform is highly customizable to meet the evolving needs of specialty pharmacy and maintains a large market with major clients such as Walgreens Specialty.1
Although this a widely used platform, it may be considered by some to be prohibitively expensive that only the largest specialty pharmacies can afford. However, ScriptMed has introduced less expensive options to attract the smaller independent pharmacies that may have previously not been able to afford this platform.
Many specialty pharmacies that cannot afford more advanced systems are also using other platforms that have historically been focused on traditional pharmacy. The pharmacies using these systems may rely on other platforms to manage the sophisticated needs of specialty pharmacy patients and products such as process flow management, comprehensive data capture, status dashboards and reports, and Risk Evaluation and Mitigation Strategy (REMS) management.
Ancillary systems may include TherigySTM, Asembia-1, and CTM (MHA). In some cases, these platforms are able to integrate with a specialty pharmacy’s adjudication system, however many manage these platforms independently.
To manage the sophisticated data needs of more complex therapies, some large and sophisticated providers, such as CVS, PANTHERx Rare, Accredo, and Diplomat have built their own inhouse workflow management and data capture platforms. In some cases, these proprietary platforms integrate with existing dispensing platforms; however, they are able to communicate bi-directionally.
PANTHERx Rare, for example, has developed a proprietary platform called Specialty Workflow TechnologyTM (SWFTTM), which is bidirectionally integrated with an adjudication platform.
This process/patient management system allows PANTHERx to build their processes and workflow entirely around the unique needs of each product and patient population with minimal development time. SWFTTM is able to capture essentially any data element at any point in the patient journey.
It is also able to offer status reports on this data, manage REMS programs, prioritize patient calls, initiate automated texts and e-mails, and offers many other customizable features that PANTHERx has developed in-house.
Increasing Importance of Capturing Comprehensive Program Data
As the specialty pharmacy industry matures, it is becoming more critical to not only manage the advanced needs of specialty pharmacy products and patients, but also capture and report on comprehensive data. Many existing specialty pharmacy systems managed by a third-party vendor have limitations in the data that they capture and updating the platform to capture new data elements can be time consuming and costly.
Some in-house systems may be preferred by a manufacturer due to their customizable, nimble, and comprehensive data capture capabilities. These data can be critical for pharmaceutical manufacturers, as they have been able to understand and act upon data faster than ever, improving the success of product launches and the lives of the patients they serve.
Understanding reimbursement data can help manufacturers improve processes at specialty pharmacies by adapting patient and health care provider outreach plans. Manufacturers can also educate physicians’ offices so that the appropriate information is being collected upfront and claims can be approved faster.
Relations teams can analyze payer data provided by a specialty pharmacy, identify payers that are denying claims, and negotiate with these payers to improve access to their product. Reimbursement data can also be useful for a manufacturer to understand the amount patients are paying out-of-pocket and update their co-pay assistance program accordingly to ensure easier patient access.
Specialty pharmacies may be able to analyze patterns and insights around the regional distribution of patients, prescriber habits, and payer patterns. If the specialty pharmacy can communicate these findings to a manufacturer, the manufacturer may reallocate and retrain their patient access and sales teams based on this information, allowing for a more successful launch.
Although these data can be useful, most emerging manufacturers are not equipped to consolidate, clean, and display a comprehensive view of their program across the hub and specialty pharmacies in their network. Most pharmacies in a network, for example, may use a specific set of status and sub-status codes in their system, which cannot be changed.
There would be no way, therefore, to view their entire patient population at an aggregate level in a consistent manner. Data aggregators, such as LiquidHUB and Prometrics, are able to provide an aggregated and consistent view of these data in a near real-time view.
The manufacturer can then analyze trends and view cases across their network. This can be particularly valuable in a portal format, allowing manufacturers’ field-based patient access teams to work with physicians’ offices and accelerate access to therapy.
If a pharmaceutical manufacturer is able to find the right specialty pharmacy partner and enter into an exclusive distribution network, this model eliminates the need and costs associated with data aggregators. This exclusive model also limits the monthly fees manufacturers must pay their specialty pharmacies to receive data. If a manufacturer has a wider network of pharmacies, the fees they pay to receive these valuable data can reach hundreds of thousands of dollars each year.
Payers are also requiring more outcome and care management data to justify the high costs of specialty products. This supplemental, post-launch information can be crucial for a manufacturer when negotiating reimbursement and potential rebates.
Outcomes-based data are particularly important for products that treat rare and orphan disease patients. Due to the smaller number of eligible patients in orphan populations, rare products have significantly smaller clinical trials.
If a product is awarded an accelerated rare disease voucher, the clinical trials may be shorter than standard trials. With limited trial data, the FDA may conditionally approve a rare disease product for certain indications.
It is possible to utilize post-approval data, captured by a specialty pharmacy, to reconvene with the FDA. With positive data, some manufacturers may be able to update and improve their product’s label and potentially eliminate additional requirements, such as REMs programs, giving the manufacturer a significant competitive advantage. Data measured after a launch can also give the manufacturer and network partners additional insights into how the drug performs and implement methods to improve efficacy, patient adherence, and retention.
As new specialty products continue to be approved at record rates, the sophistication associated with managing these products continues to increase. In order to manage these needy patient populations, collect critical data, and report these data to network partners, pharmacies are becoming more reliant on specialized process flow technology and advanced patient management platforms.
Some specialty pharmacies not satisfied with existing third-party solutions have built their own proprietary systems. If a program is launched with the right technology that captures critical patient data, manufacturers can increase the likelihood of a successful product launch and continually improve their program. These data capture and sophisticated patient management programs highlight the importance of selecting the appropriate specialty pharmacies when launching new products and managing complex disease states.
1“Transforming Specialty Pharmacy Operations to Deliver Better Patient Care.” Population Health Learning Network, 23 Apr. 2019, www.managedhealthcareconnect.com/content/transforming-specialty-pharmacy-operations-deliver-better-patient-care.
About the Author
Gannon Vanscoy is the Director of Specialty Markets at RareMed Solutions, the nation’s first rare disease focused specialty pharmacy HUB. Gannon leads RareMed’s overall business development efforts and manages strategic partnerships across the company’s portfolio. Gannon began cultivating his expertise in rare and orphan disease states at PANTHERx Rare Pharmacy, where he participated in a rotational development program focused on hub services. Prior to working at PANTHERx Rare, Gannon served as a leader at a number of large multi-national banks, both in internal and client-facing roles.
Gannon earned his Bachelor of Business Administration degree from the University of Miami and is currently pursuing a Master of Pharmacy Business Administration (MPBA) from 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.