NASP Q&A: How Health Care Reform Could Impact Specialty Pharmacy


New National Association of Specialty Pharmacy executive director discusses potential changes to the specialty pharmacy landscape.

Industry veteran Sheila Arquette was recently named executive director of the National Association of Specialty Pharmacy (NASP). Arquette has extensive experience in areas such as retail pharmacy, hospital pharmacy, and long-term care consulting and dispensing, prior to leading NASP.

In an exclusive interview with Specialty Pharmacy Times, Arquette discussed her upcoming goals for the organization, as well as challenges to be addressed in the specialty pharmacy landscape.

SPT: What is your vision for NASP?

Arquette: My vision for NASP is to become the premiere specialty pharmacy trade organization, but with the ultimate goal of representing the needs of our membership, and at the heart of that is taking care of the patients that we’re all committed to serving. How do we all work together, how do we all come together and identify issues or barriers to care, or barriers to these patients achieving the therapeutic outcomes that we’re all looking for? And how do we work together to develop solutions to those problems? Everybody talks about the issues, the issues, the issues. Okay, we know what the problem is, or where we perceive there to be a barrier or problem, but now what can we do about it? How can we work together? There’s so many smart people in this industry, just like there’s so many smart people in this organization. I’ve seen that over the last 18 months to 2 years that I’ve been involved, and I’ve watched the organization evolve. When people come together and start talking and sharing ideas, having an open, honest conversation and dialogue, that’s where these solutions are born.

SPT: What are some of your goals for this upcoming year?

Arquette: We recently engaged with a DC-based lobby firm, and what we’re trying to do is work collectively and get out on the Hill, get in front of CMS, and raise awareness to what specialty pharmacy is, because right now I think that is probably one of our biggest challenges. When you talk to the average person—–or even the average legislator or staffer––when they think of pharmacy, they think of the pharmacy on the corner, their retail pharmacy. Everyone’s probably been touched by that, had a prescription filled at some point. So, when you talk about specialty pharmacy, there’s kind of this look, like they understand it’s probably different, but how is it different? And why does it matter? What patients are we talking about, what diseases are we talking about, and why does it matter? Why is it different from somebody who just needed a 10-day amoxicillin prescription, who went in and got it filled and in 10 days they were better. Why are all these coordinated services that are so integral in driving these outcomes, why are those valuable and why are those needed, and what goes into that. How is a specialty pharmacy infrastructure different? So, it’s working with the folks that we’ve partnered with to try to educate and advocate. This is who we are, this is who specialty pharmacy is, this is who NASP is. This is our mission or vision, this is what we want to do, this is who we represent, this is how we feel we benefit the health care delivery system and the whole health care ecosystem. How do we help with total cost of care, and how do we help these patients manage their chronic diseases and live more productive, full lives. How can we help.

Some of my other objectives for this year are building out pharmacist education. We have an entire education committee dedicated to the continual re-education, because this is such a rapidly changing industry and it’s so fast paced—–new treatments emerge and are approved every day. They are committed to specialty pharmacist continuing education and certification. We have a certification program that requires an exam, and it’s a credential that specialty pharmacists can add to their resume, highlighting the fact that they’ve mastered the topics of this pharmacy practice setting. I’m very committed to supporting that committee and to building out our educational programs, having NASP be seen as a premiere source for this education.

We also have an annual conference that we hold every year and I’m very engaged with that. It’s just a great opportunity to bring people together across this whole spectrum of stakeholders who participate in the care of these patients, and get them together, and get them to start networking, collaborating, and learning about how each contributes to the care of these patients. Where are our synergies, where are our opportunities. Promoting that meeting and trying to bring in thought leaders to provide the education that’s required is another area of my focus this year.

SPT: With the impact of the health care reform on specialty pharmacy, what are your hopes and concerns?

Arquette: Right now, the specialty pharmacy industry is being threatened by these (direct and indirect remuneration) DIR-fees that’s threatening our member organizations’ ability to continue to participate right now in Medicare Part D networks. For me, I’m coming from the payer side. I administered a Medicare Advantage Plan, in addition to a PDP, and I know that it’s all about beneficiary access and choice. When you limit access that isn’t in anybody’s best interest. I think competition spurs innovation, it spurs people to strive for higher quality to achieve better things.

We are focused on DIR fees and we’re trying to get people to appreciate how that impacts a specialty pharmacy’s ability to care for patients, because it often times results in negative margins. It’s very labor intensive to dispense these prescriptions. I think we have to highlight the impact that it’s having not only on the pharmacies, but also the members, because it affects what they pay out of their pocket, and then ultimately, at the end of the day, what Medicare itself pays. As you follow the dollar through the process and through the phases of the Medicare beneficiaries’ benefit, once you get a member into catastrophic coverage, Medicare picks up 80% of that to reinsurance back to the health planner, the PBM, whoever the payer is. There must be an increased appreciation for this; this is going on, this is how it’s detrimentally impacting all of these people along that continuum.

We’re focused on DIR fees, we’re focused on any willing provider. Our pharmacies want to be allowed to participate in these networks, they want to be able to demonstrate their value, what they can bring to the table. So, we want to make sure the requirements that they’re being held to are reasonable and relevant to their practice settings. We also want to talk about specialty pharmacies’ specific quality metrics. A lot of these DIR fees are based on performance measures, or performance metrics, that are related to primary care practitioners or something a retail pharmacy would be able to have an impact on, like generic sell rates and the percentage of patients on statin therapy, or for the management of diabetic patients and statins. That’s not something that a specialty pharmacy has any type of control on, nor do they practice in that space. What we’re looking for defining quality metrics relevant to specialty pharmacy for which we could be measured against. So, how do we do that and how do we get people to understand that they’re different.

SPT: With the new administration in the White House, can you describe the importance of advocacy and lobbying lawmakers to give specialty a voice?

Arquette: Everything I hear from working with the folks that we’re working with now, is the new administration is very open and receptive. They want to learn, they want to understand, they want to develop solutions. It’s very important for NASP to be out there and have our voice heard, and be at the table to help develop these solutions—–and again providing the education. You’re new administration and you’re taking care of everything for the entire country, so we have to take it upon ourselves to be the experts and provide that necessary education, so that we can move things forward in a way that we feel would be most beneficial to all parties involved. It’s a very exciting time in Washington, it’s a very exciting time in health care, and it’s great for NASP to be out there promoting our message and working in conjunction with the administration to move these things forward.

SPT: What impact will the Affordable Care Act replacement plan have on specialty pharmacy?

Arquette: I’ve been reading through it and trying to digest it, and I think it’s a little bit early. I read something about Medicaid reimbursement perhaps moving to a per-capita type reimbursement model, and these medications sometimes can be expensive, so I get a little bit concerned about that. Will there be some impact on access for some beneficiaries? I also get concerned anytime I hear that people are going to move back to being uninsured, perhaps. I think it’s demonstrated that if you can get people engaged in the health care system at the primary care level, dealing with the primary care doc and taking care of their health proactively, and doing population health-based initiatives and preventative care, that it saves in the long run. But again, people have to have access to health care and it has to be affordable. So, I’m just watching and waiting and to see what impact it will have.

This is another great opportunity for NASP to be out there to help educate, because sometimes, something that looks good on paper, when you start discussing it and start going through the potential issues that you’re going to have, then somebody gets an entirely different viewpoint. I’m hoping that that’s what we can be, we can be somebody that gives the 360-degree view of some of these resolutions, what may happen as an unintended consequence.

SPT: Is there anything you want people to know about NASP?

Arquette: I’m very excited and I hope that any of your readers who are interested, and if they have questions and want to get involved, that they reach out to me. We’re an organization that is fueled by the wonderful volunteers that we have. Their commitment and their dedication, and passion is overwhelming to me, and there’s no way that I could do any of this without them. I think I’m just kind of the support person trying to pull it all together, see where there’s gaps, and see where they need support, so they can keep doing the great things they’re doing. If there is anyone who has questions or wants to get involved, I would love it if they reached out to me.

Click here for more information on NASP.

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