Real-world metrics demonstrate that using health-system specialty pharmacies (HSSPs) means everyone wins: health systems, clinicians, and patients.
What makes integrated specialty pharmacies so effective? Pharmacists are part of the patient care team and have access to the electronic medical record (EMR) and appointment schedules, which allows them to coordinate and advocate for patients through a high-touch, white-glove care model.
These advantages enable the health-system specialty pharmacy (HSSP) team to defragment care, promote better patient outcomes, and reduce the total cost of care.
Health systems have begun to view patients as active participants who have a role and responsibility in their health care decision-making.1 As HSSPs work to understand the wants and needs of their patients and providers, they can customize the specialty pharmacy care model to ensure it aligns with these priorities.
Patient satisfaction is an important measure for specialty pharmacies and accrediting agencies.2-4 One way to measure satisfaction is to include a question about Net Promoter Scores (NPS) in patient surveys.
A high NPS reflects the increased likelihood that the patient would recommend the specialty pharmacy to a friend or colleague. Despite abysmal NPS scores widely reported across many non-health care industries, HSSPs achieve high NPS scores, typically in the 80s, which indicate excellent customer satisfaction. This metric can also be useful during payer contracting negotiations.5
Integrated specialty pharmacies have demonstrated that implementing patient-centered programs, such as centralizing prior authorizations (PAs), integrating therapy management into specialty clinics, and creating health coaching options, increases patient satisfaction.6-8 HSSPs have also achieved significantly greater provider satisfaction ratings compared to external specialty pharmacies.9 Health care providers perceive HSSPs to be superior to external pharmacies in streamlining clinic workflow, reducing provider burden, increasing medication access, improving communication, and enhancing patient care.
Time to treatment (TTT) initiation is the time between when a prescription is written to when the patient takes their first dose. HSSPs facilitate quick initiation to therapy, which can have an incredible impact on the outcome for the patient, particularly those with complex disease states.
Part of reducing TTT is improving the PA process, which typically requires an average of 2 days per week of paperwork by clinical and administrative staff. More troubling was a 2020 physician survey completed by the American Medical Association in which 94% of respondents noted a delay associated with PA, with 79% reporting that PA delays can lead to treatment abandonment.10 HSSPs can help expedite the PA process by accessing EMRs, allowing pharmacy teams to complete the paperwork themselves.
Restrictively high insurance co-pays for medications can create a financial barrier to specialty medications. This is especially true toward the beginning of each year when insurance deductibles are unmet.
For example, novel oral anticancer agents are increasingly prescribed but their high cost can lead to financial stress and impact the well-being and quality of life for patients and caregivers.10
To promote quicker time to therapy, HSSPs often have staff dedicated to obtaining co-pay assistance for patients.11 HSSP staff are trained in the nuances of co-pay assistance programs available through drug manufacturers and can complete the forms.
Some HSSPs also have dedicated medication assistance program coordinators who help patients apply for grants available through disease-specific foundations, track when grant funds are depleted, and monitor for new grants that become available. As a last resort, HSSP staff can help patients enroll in manufacturer patient assistance programs, which provide free drugs to patients when other financial assistance options are not available.
There have been several studies that demonstrate not only improved health outcomes from the HSSP clinical model but significantly improved cost avoidance. The high number of touch points and the coordination of patient care between pharmacist and prescriber leads to a faster access to medication and improved adherence rates.13 These, in turn, lead to faster alleviation of disease symptoms, fewer acute care visits, and lower readmission rates.14,15
Other helpful intervention outcomes identified in studies include prevention of therapy complications, resolved adverse effect challenges, elimination of therapy inappropriateness, and prevention of premature discontinuation.16
For example, a Cleveland Clinical Specialty Pharmacy study showed 547 pharmacist interventions on specialty hematology/oncology patients over a 5-month period, which resulted in a total cost avoidance of $1,508,131.17
Another study in 2020 across 26 HSSPs showed that for 56,772 patients on specialty medications, 7393 interventions by pharmacy staff resulted in a total cost avoidance of $15,292,883.18 These results are just a few examples of emerging analyses suggesting that the use of an HSSP is associated with lower total medical costs.
An HSSP is distinctively positioned to generate exemplary patient outcomes through personalized engagements with patients and providers. Pharmacists can increase adherence, address affordability barriers, and identify medication interventions, all of which contribute to improved quality of life and lower disease severity.
Best practices and benchmarks continue to evolve. Although HOSP believes that HSSPs represent the gold standard, we encourage the US health care ecosystem to collaborate with key stakeholders to allow patients to have the choice to fill at their HSSP. After all, we want to see improved care for all patients and remove barriers to a successful treatment journey.
About the Authors
Jennifer L. Donovan and Agnes Cha, Health-system Owned Specialty Pharmacy (HOSP) Alliance Health Economics and Research Outcomes Committee (HERO) Committee Co-Chairs, with support from HOSP HERO Committee members.