Payer requirements for outcomes data are becoming more stringent.
Specialty pharmacies pride themselves on providing patients and other stakeholders with optimal outcomes proven by meaningful data. With the many moving parts of the specialty landscape, it may be challenging for pharmacies to provide in-depth data for each stakeholder, especially with a lack of data standards.
In a session presented at the National Association of Specialty Pharmacy (NASP) Annual Meeting and Educational Conference, experts discussed the key outcomes measures and how expectations from payers are evolving.
These outcomes are the essential concept of what a pharmacy does and how it works. Examples include time to first fill, call center metrics, error rates, and turnaround times.
“These are the absolute nuts and bolts and process measures of how specialty pharmacy takes in a prescription and gets it out to the patient,” Kyle Skiermont, PharmD, chief operating officer at Fairview Pharmacy Services, said during the session.
Some may also argue that patient or provider outcomes may be under this category as well, according to the session.
Patient assistance and co-pay assistance programs fall under this category. Also included are the cost to fill a prescription, disease state, per member per month, or other cost-related metrics requested by a payer.
A key thing for a health system pharmacy is the total cost of care, which many other specialty pharmacies may not be able to determine due to lack of data, according to Skiermont.
These outcomes are among the most crucial measures for patient success on therapy. These measure adherence, adverse events, and side effects. Skiermont reported that there has been a shift towards disease-specific outcomes, such as sustained virologic response for hepatitis C virus (HCV) and days of work missed for multiple sclerosis.
Specialty pharmacies must report various outcomes to multiple stakeholders, which adds a layer of difficulty since each facet needs specialized information. The biggest consideration for outcomes is the audience and to ensure that they are receiving the proper data, according to the session.
Benchmarks are also a huge consideration, which is why NASP has been working to craft core metrics so every pharmacy is reporting the same things. What competitors are reporting and what differentiates pharmacies are important for outcomes reporting as well, according to the panel.
Skiermont also mentioned the impoartance of data considerations to outcomes, such as whether the pharmacy has the necessary information that is reportable and whether the data are significant.
“As far as outcomes go from a payer perspective, it has developed drastically over the past 2 years, as I’ve seen payers get a lot more saavy,” Keith Cook, RPh, vice president, MedImpact Direct Specialty, MedImpact Healthcare Systems, Inc, said during the session. “They’re expecting more. They’re raising the bar consistently.”
For payers, cost is a top reason why outcomes are so valued, according to the panel. They ask the question, “did I get what I paid for?”
Despite high initial costs, avoiding even higher costs down the line is ideal.
Payers also expect optimal adherence rates to ensure that the high cost of therapy is worth it. Cook reports that some payers expect an adherence rate of more than 90% for cancer drugs and more than 95% for HCV drugs.
“As the cost [of the treatment] goes up, so do the expectations,” Cook said.
With high-cost treatment, the importance of data and metrics to payers becomes amplified. Payers require outcomes data that are benchmarked against the whole disease state and compare outcomes for other drugs. Meaningful clinical reports are also significant for costly specialty treatments, according to the session.
The takeaway of the session is that payers are requiring much more detailed and in-depth outcomes reports as time goes on. Specialty pharmacies must remain in-line with these trends, but it may require data standardization, presenting an additional challenge, according to the panel.