Keys to Managing Specialty Pharmacy Stakeholders
Factors for meeting the varying needs of patients, providers, manufacturers and payors in specialty pharmacy.
With the tremendous amount of competition in the specialty pharmacy landscape, pharmacies must look for ways to differentiate themselves, and provide the best possible experiences and services to all of their stakeholders.
Specialty pharmacies routinely work with patients, providers, manufacturers and payors. Below, we examine key stakeholders across the specialty landscape and look closely at what each constituent may place emphasis on when selecting their pharmacy provider.
In a traditional pharmacy setting, patients have considerable control when selecting a pharmacy to fill their prescription. They may select a pharmacy based on convenience, price, or prior experiences with the pharmacy staff.
When patients are prescribed medications that are specialty therapies, they often will not be familiar with the pharmacy filling their prescription. In addition to being unfamiliar with the pharmacy filling their prescription, patients will also be trying to gain education and understanding regarding their newly diagnosed condition, and the therapies used to treat it.
This serves as an excellent opportunity for specialty pharmacies. The ability of the specialty pharmacy to establish a relationship with the patient is vital to the success of the patient’s treatment journey. This requires the specialty pharmacy to conduct proactive outreach to the patient once a prescription is received.
During the introductory call by the specialty pharmacy, it is important to explain who the specialty pharmacy is, what services they provide, and what next steps to expect while the patient is beginning therapy. It is the responsibility of the pharmacy to explain what is different about their prescribed therapy from traditional medications available at retail, and offer patient education.
Providing the patient with a concise timeline of expected future outreach, and when their first shipment will arrive is also essential. Lastly, the ability of pharmacies to utilize external funding sources for eligible patients is a valuable service that they can offer to their patients.
Financial assistance through copay cards, disease specific funds, etc, is available for many specialty therapies, and allows many patients to begin therapy with their prescribed medications.
Providers have their own set of criteria when selecting a specialty pharmacy to process prescriptions for their patients. First, providers enjoy working with a specialty pharmacy that can offer a streamlined and efficient approach to initiating and maintaining their patient population on specialty therapies.
This requires specialty pharmacies to be easy to reach and accessible. Specialty pharmacies may choose to offer physician portal access, or hire a designated provider relations liaison who will serve as a point-of-contact for the referring offices.
Providers may also wish to select a pharmacy based upon performance metrics, such as the proportion of patients successfully started on therapy, time-to-fill, or medication possession ratios. Pharmacies that are able to demonstrate an ability to perform well across these metrics should strongly be considered by physician practices.
Physicians may also want prior authorization support for their patients. Many specialty therapies require prior authorization, and in some instances, the appropriate forms may be difficult to find online and require considerable time to fill out.
Effective collaboration between the pharmacy and physician office, as well as new cloud-based technologies, such as SamplifyRX, can shorten the time required to complete the proper documentation, and lead to successful insurance approval.
Manufacturers have increasingly become more involved in patient care. Manufacturers want to align themselves with a pharmacy that gives their product the best chance to reach as many patients as possible. In fact, many manufacturers have designated support staff departments that work closely with the pharmacies to ensure patients have access to their therapies.
Manufacturers will select specialty pharmacy networks based on multiple criteria. The ability of a pharmacy to offer a customizable and tailor-made programs for a manufacturer therapy is an extremely favorable trait to a manufacturer.
Manufacturers will try to accurately forecast the utilization of their product and determine which model of distribution (open, limited, exclusive) may be most successful for their product. Once manufacturers have a sense of the channel strategy that will be utilized, they will begin to evaluate pharmacies on criteria such as accreditation (ACHC and URAC), prior experience with similar therapies, and patient populations, as well as data collection/customization.
REMS management, delivery capabilities, and depth and breadth of clinical programs offered will also be primary factors when manufacturers choose to work with a pharmacy. They also want to ensure that the pharmacy has a broad reach and is well contracted with commercial, state, and federally-funded insurance programs to prevent delays in patient care.
Additional criteria such as overall patient satisfaction scores, time-to-answer, and inventory consignment may play a role in specialty pharmacy selection.
Payors can also derive value from pharmacies. Payors want to ensure that the appropriate care is given to each patient. Through collaboration with the pharmacy and provider, payors can be certain that the prescribed therapies are both safe and appropriate for each patient.
With the emphasis on value-based care and outcomes that has begun to reshape the delivery of care in the United States, payors are focused more than ever on the outcomes achieved through medication use. Specialty pharmacies are poised to provide patient education, support services, and financial assistance programs in conjunction with medication therapy to achieve optimal outcomes of pharmacotherapy.
A large majority of pharmacies also offer many sophisticated reporting options that can demonstrate positive outcomes that traditional pharmacies do not. Payors who employ specialty pharmacy utilization practices effectively will generate positive outcomes for their patients.
Successful specialty pharmacies will have an in-depth understanding of what each stakeholder seeks. Above all, the pharmacies and other stakeholders that establish relationships of trust, and share a common vision for their patients, will provide the highest quality of service and have the greatest impact for those who they serve.
Scott Pribyl. “Digital Patient Adherence Strategies for Specialty Pharmacy.” Drug Channels. April 29, 2016. June 1, 2016.
About the Author
Justin Smerker earned his PharmD degree from the University of Pittsburgh in 2009. He is currently a clinical pharmacist for PANTHERx Specialty Pharmacy. He has experience in the implementation and delivery of high-touch patient care services as well as in clinical management, persistency, and adherence programs. Justin also has participated in assisting with the successful launch of newly FDA approved medications. He has served as an adjunct clinical instructor for experiential education at Duquesne University. Prior to working in the specialty pharmacy sector, Justin successfully managed high volume retail pharmacies. Justin is currently enrolled in the Masters of Science in Pharmacy Business Administration at the University of Pittsburgh.