Specialty pharmacies must engage each individual patient to ensure optimal treatment outcomes.
Start Me Up: Not the Beginning of the Journey
Specialty pharmacies (SPs) can easily mistake the arrival of a new start to therapy as the commencement of a patient’s treatment. However, these patient populations have endured an arduous diagnosis process prior to being prescribed a specialty medication.
Having seen multiple doctors, often finding more questions than answers, the diagnosis is the culmination of anxiety and frustration, on top of the malady the patient is afflicted with. This time in the patient’s experience, which is permeated by so many negative emotions, is further complicated by having to obtain treatment through an unfamiliar means.
While the value added from a SP can be easily articulated, these benefits are lost if the specialty pharmacy is unable to engage each individual patient in a positive fashion. The onboarding process is paramount to achieving this end.
If effectively executed, the SP can establish itself as a lynchpin to optimal patient care, allowing enrollment at the pharmacy to coincide with the beginning of clinical improvement.
Miss You: Bridging the Gap between Retail and Specialty
Before the explosion of specialty therapies established SPs as a primary channel, retail pharmacies dominated the distribution landscape. The popularity of this system is easy to understand.
Repeated face-to-face interactions facilitate relationships between patients and pharmacies. The strength of these relationships is inherently tied to the ease of two-way communication.
The pharmacy is in a fixed location with fixed hours of operation, allowing patients to supplement incomplete understanding on demand through a familiar dynamic.
Specialty pharmacies must strive to achieve similarly steady relationships with its patients. CVS, through its innovative Specialty Connect1 program, leverages the company’s structure to allow back end specialty operations to be delivered through the existing retail paradigm.
However, most SPs do not enjoy the luxury of an integrated retail network. Other specialty pharmacies should consider single points of contact or dedicated therapy teams, harnessing the rapport achieved from repeat interactions.
To jumpstart the relationship-building process, prescribers must be actively engaged to bridge the initial communication gap. Many specialty pharmacies already employ physician-facing sales teams.
Already championing their organizations’ ability to act as collaborators in patient care, the sales force can also provide prescribers with information regarding the initial pharmacy to patient contact. Through pamphlets, or simply business cards, the pharmacy can equip practitioners, and subsequently patients, with expectations for how they will obtain their first life-altering medication delivery.
Since most specialty prescriptions are sent directly to the pharmacy, tangible take-home information can minimize unnecessary patient confusion.
You Can’t Always Get What You Want: Ensuring Patients Get What They Need
Even with the prominence of mail order pharmacies, receiving medication from the postman is often met with resistance. Among other reasons, mail service pharmacies are notorious for substandard communication.
Delivering traditional medications through the mail, juxtaposed to specialty therapies, is markedly lower stakes, as retail pharmacies are able and willing to supplement medication and counseling when mail service falls short. However, specialty pharmacies are operating on an island.
Further complicating the situation is that initial approval of specialty therapies often requires the navigation of complex systems. Ranging from reimbursement assistance to prior authorization approval, no entity is better suited to advocate for patients than a specialty pharmacy.
Unfortunately, the gold standard to dispense the first prescription is measured in weeks. Failure to keep patients informed of their prescription status risks patient frustration, and possible medication abandonment.
Mitigation of this risk is simple in concept, yet complex in its execution. The first pharmacy contact with the patient must include an explanation of the necessary steps before providing his or her medication.2
By setting expectations, the SP can proactively take control of an otherwise complex and confusing situation.3 While a patient may not need to understand the details of a health plan’s step therapy protocols, he or she needs to be informed about the foundation of this new dynamic: communication.
Can’t You Hear Me Knocking: Proactive Communication Management
Due to the variability of each patient’s first fill, leveling expectations for pharmacy outreach can be challenging. Beginning with prescription receipt, order completion may involve some, or all, of the following: data entry, clinical documentation, claim adjudication, prior authorization request, denial, appeal, approval and payment assistance.
Since no two of these prescription “snowflakes” are identical, creating a cookie cutter approach for patient communication is daunting.
Instead of focusing on milestones that may or may not occur, the SP should focus its communication plan on a consistent benchmark—time. Each contact with a patient should end with a summary of the next steps toward medication approval, and the anticipated time for these steps to be completed.
Subsequent communication can be active (I’ll call you once this is resolved) or passive (call if you have not heard from me in 3 days), but must be explicitly stated. Regardless of the approach, the patient must be encouraged to reach out to the pharmacy at any time to check the status of the prescription.
Satisfaction: Transitioning Referrals into Active Patients
By the nature of their practice, specialty pharmacies inherit critically ill patients right before they are finally afforded an opportunity to treat their condition. Even though access to medications is ultimately derived from the collaboration of providers, payers and SPs, the pharmacy is viewed as the gatekeeper to life-altering therapy.
Staunchly advocating for their patients is merely part of the SP role. They must work diligently to set and meet expectations for communication.
In doing so, specialty pharmacies can not only deliver valuable clinical outcomes—they can provide satisfaction.
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.