Measuring Success in Specialty Pharmacy Practice

Specialty Pharmacy Times, November/December, Volume 8, Issue 7

With an increasing portfolio of specialty products and dollar volume, the value of these treatments must continue to be demonstrated. 

Data and Documentation: Focus on the Big Trends

A key mantra in health care has always been “If you don’t document it, you did not do it.” Well, that goes for measuring value, often in the form of quality metrics, and only in this way will specialty pharmacy be in a position to demonstrate its positive impact. Each therapeutic class or disease state presents itself with potential measures. These measures can be based on multiple factors, including quality, improvement/cure, outcomes, adherence, cost, and potentially many more. The measures can also frequently be subjective, based on how the patient feels.

With an increasing portfolio of specialty products and dollar volume, the value of these treatments must continue to be demonstrated. The acceleration and growth of specialty continues to be affirmed, as evidenced in the data in Figure 1. Specialty is quickly approaching 50% of the spend and accounts for under 3% of the total prescriptions being filled, a concentrated mix.

Specialty pharmacies generally focus on key disease states and work hard to provide the best service possible on the drugs that best meet the patient’s needs for those disease states. While we continue to be blessed with existing and emerging products that treat many disease states, the reality is, according to QuintilesIMS, that the top 5 disease states constitute 75% of drug spending (Figure 2). It stands to reason that if a pharmacy is going to be successful, it must incorporate some or all of these disease states.

Measuring Outcomes: Setting Specialty Up for Success

In most cases, the services provided by specialty go far beyond dispensing, and that value must be measured. While focused specialty pharmacies concentrate on key measures in their business as a whole, standards have not been clearly established within the industry. The Pharmacy Quality Alliance (PQA), with input from the National Association of Specialty Pharmacy (NASP), released its Specialty Core Measure Set to assess adherence and persistence for several important specialty therapies in the top 5. These measures at the health plan level fill a gap in the market and will have a positive impact on appropriate medication use and patient outcomes.

The set of PQA-endorsed measures includes:

•Treatment of Chronic Hepatitis C: Completion of Therapy

•Adherence to Antiretroviral Medications

•Adherence to Non-Infused Disease Modifying Agents Used to Treat Multiple Sclerosis

Next up for PQA will be Adherence to Non-Infused Biologic Medications Treating Rheumatoid Arthritis (auto-immune), so 4 of the top 5 will be covered. PQA developed these measures to address the gap in specialty measures in the marketplace that were identified with help from NASP.

The objective of the Specialty Core Measure Set used in its entirety or individually will enable key stakeholders such as specialty pharmacies, health plans, and pharmacy benefit managers to understand the impact of their quality initiatives to support the health and outcomes of specialty patient populations. Patient adherence to drug therapy is the top mission for specialty pharmacies. By measuring adherence and persistence of 4 of the top 5 disease states, pharmacies can best assure optimal outcomes for patients. The plan is to leverage these core data sets and pair them with a payer’s service-level metrics, patient experience metrics, or other metrics, to holistically assess plan members’ medication use. Given the key role that NASP members and other specialty pharmacies play in the specialty care continuum, a collaborative approach is critical.

Differentiating Specialty Pharmacy and Value-Based Contracting

Specialty pharmacy has become a focal point of data convergence. In the case of specialty products, the interpretation of and action taken by specialty pharmacy in the management of pharmaceutical care—including the interaction with multiple payers utilizing their professional expertise to reduce abandonment and improve adherence—is the point of differentiation.

With the continued battle of finding a “political solution” in covering the cost of health care in the United States, stakeholders must be willing to prove value. Value is generally defined as the result of quality divided by cost or the health outcomes achieved per dollar spent. Value-based contracting involves payment or reimbursement based on indicators of value, such as patient health outcomes, efficiency, and quality. To get there, we must focus on key elements, such as:

• The number of dollars spent on a medication versus other associated health care costs

• Finding specific measures and how those measures can be tracked against key benchmarks; for example, measuring the sustained virological response test for hepatitis C products over a period of time to measure cure rates

•Providing portability in these measures as patients may go from 1 plan to another over the course of a patient’s treatment

The Four P’s: Patient, Providers, Pharma, and Payers

All 4 of the P’s fit into the data mix. Pharma and payers are interested in seeing measurable outcomes for the drugs prescribed to patients. Pharma wants to claim that its product—if used correctly—will decrease the progression of disease, reduce visits to the emergency department, and achieve positive outcomes. Pharma wants to compare its product to others on the market to show its efficacy.

Payers have a similar interest; they look for products that decrease cost, reduce hospital admissions, and improve patients’ quality of life by lessening their disability and reducing absences from work due to illness.

Both pharma and payer stakeholders need access to comprehensive internal data and look to specialty pharmacies to provide it. Specialty pharmacies must improve their ability to measure outcomes to claim that the health outcome for the patient was improved as a result of their action. Lastly, both pharma and payers are reliant on the data that specialty pharmacies provide to demonstrate that a product is having an impact, that the patient’s condition is improving, not worsening.

The measures that have and will be developed by this specialty pharmacy consortium will give specialty pharmacies an opportunity to differentiate themselves to both commercial and government payers.

NASP Annual Meeting

Specialty pharmacy is all about taking patient care to the next level through the interactions of professionals often working with other professionals in a collaborative environment. We take great pride in the role of Specialty Pharmacy Times® as a mouthpiece for our industry and an educational tool for our readers. Education is a continuous process, and training and personal improvement often come through live interactions with our peers. NASP recently concluded its fifth annual meeting, which proved to exceed expectations of all the nearly 1000 stakeholders in attendance. Specialty Pharmacy Times® proudly played a special role this year as the official meeting planner. There are many highlights from this event that we are covering in this month’s edition, but these cannot come close to being there in person. We encourage you to attend next year’s premier educational event, scheduled for September 16 to 19, 2018, at the Marriott Wardman Park Hotel in Washington, DC. Planning for the 2018 program is already under way with the leadership of your specialty pharmacy peers, dedicated individuals who have taken time and effort from running their own business to lend a hand and advance the profession, all with a focus on better patient care. The programs offered will include comprehensive information regarding all aspects of specialty pharmacy and—because the event will be held in DC—national legislative and regulatory policy. The annual meeting will also offer an opportunity for you to differentiate yourself, specifically through the Certified Specialty Pharmacist exam by the Specialty Pharmacy Certification Board (http://naspnet.org/csp-certification).