Pharmacy Information Systems: The Platform for Elevating Care in Specialty Pharmacy

New physician referral for a specialty medication: check. Insurance verification and prior authorization approval: check. Medication on-hand to satisfy the referral request: check. Pharmacy information system capable of claims adjudication, referral management, ongoing clinical management, and data aggregation: help!

Specialty pharmacy has truly revolutionized every aspect of our industry. Starting with how medications are manufactured, to the way payers strategize to control costs—the need for pharmacists to acquire robust skillsets in order to clinically manage patients utilizing specialty medications. Even the prescription has evolved into what is now called a referral.

These have all been well documented and discussed in depth. What is not garnering much attention, however, is the impact specialty pharmacy has made on pharmacy information systems.

Pharmacy information systems are the silent work horses, which over the years have greatly mitigated the amount of manual work required within the pharmacy environment. They have streamlined and standardized the data entry process, reduced errors, and saved countless hours of manual manipulation. Yet, it is still easy to take them for granted, especially when they become the pain points of our day.

If you’re a pharmacist within the specialty pharmacy arena though, I want you to think about your own system for a minute. Think about how your day-to-day functions are made possible due to the pharmacy information system you work on.

Now I want you to think about what your day would be like without it. Could you still do it? Highly unlikely to impossible.

If you did though, it would be the most inefficient and unsafe way to ever practice. Therefore, let’s attempt to better understand our silent work horses.

How have they evolved? What can they do? What do they mean to us?

A History Lesson

Pre-dating the specialty pharmacy era and, even in today’s non-specialty environment, pharmacy information systems were/are not required to be sophisticated. Of course, any non-specialty pharmacy could choose to beef up its systems, but it was never a necessity.

In a non-specialty pharmacy, pharmacy information systems are fully functional and satisfactory when they can accomplish three things. Maintain patient/physician/medication demographics, adjudicate claims, and transpose information from the prescription screen onto the label.

Medications within non-specialty pharmacy do not require the same level of clinical management as specialty medications do. The referral process is less of a process and more of a task. Furthermore, only one individual is needed to convert a prescription into the finished product.

Simply put, non-specialty medications lack the intricacies and requirements that specialty medications do. Therefore, having a multifunctional and elaborate system is no more advantageous than a system adequate enough to meet the expectations of the patient.

So, why then is there such a disparity in the type of pharmacy information system needed in specialty pharmacy?

A Specialty Pharmacy Information System

Well, we briefly touched on a few reasons already. Specialty medications have an inherent amount of complexities associated with them. They are expensive and often require prior authorization before they can be dispensed. In order for a specialty pharmacy to capture this information, its system must be able track, sort, and store information about the prior authorization.

The process of onboarding a new patient requires the work of a cross functional team. This usually includes an intake team, an insurance verification team, and a clinical team. Although all 3 teams work individually, they are reliant on each other to move the process forward. Therefore, it is critical for the entire team to have visibility of the work being performed. A system capable of providing such features is a necessity.

Specialty medications often carry greater risks of causing side effects and routine monitoring is needed to mitigate this risk. Additionally, medication refills require the patient to answer a series of questions related to the medication before it can be shipped. These encounters must be documented, verified, and readily retrievable.

Data, data, data—manufacturers want to see it, payers want to see it, and pharmacies need it. A pharmacy information system that can aggregate and extract data, provides a competitive advantage for a specialty pharmacy. Having the capabilities to pull useful data can improve patient care, support process improvements, or serve as an additional revenue generator.

The list doesn’t stop here though. This is just a high level look at why it is important for a specialty pharmacy to adopt a pharmacy information system capable of sophisticated processes.

There is not a one size fits all system either, and that is a good thing. Each specialty pharmacy is unique, from the vision of the organization to the manner in which they go about achieving it.

Therefore, the challenge is not in finding a system that works, it is finding the one that best suits your needs to help drive unparalleled care for your patients.

About the Author

Joe Thomas earned his Doctor of Pharmacy degree from Duquesne University and 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. He has spent the past several years working across several specialty pharmacies, integrated in both staff and corporate experiences.