Specialty pharmacy needs to become a results-based industry that delivers superior health outcomes.
Looking back, 2015 was an interesting year for specialty pharmacy. Payor expectations mounted as an increasingly complex array of drugs entered the market while margins continued to compress.
Who can forget the increased scrutiny the specialty industry received from the media when Martin Shkreli of Turing Pharmaceuticals increased drug prices for toxoplasmosis patients by 5556% overnight?
A few months in, 2016 is shaping up to be no less interesting. Despite proposed legislation to give pharmacists the provider status that could result in FMV relief, a number of challenges will persist. Being a task-based industry that delivers drugs and considers the job done is no longer good enough. Specialty pharmacy needs to become a results-based industry that delivers superior health outcomes.
Additionally, specialty needs to close information gaps in the chain from drug development to delivery to outcomes, and, of course, payment. As value based care upends the status quo in the health care ecosystem, payers are coming to expect improved visibility and predictable outcomes from all members of the health care ecosystem, not just providers immediately affected by the legislation.
This has unique implications for specialty pharmacy. Providing visibility first requires collecting data across the entire continuum of care - not an easy task considering the complexities of coordinating drug distribution and delivery for a wide range of chronic conditions. Patients themselves are also complex, as many have multiple conditions or complicating factors that need to be managed in order to provide the desired outcome. And this level of complexity certainly isn’t decreasing.
In 2015, specialty drug products accounted for approximately half of the total new drugs and biologics approved by the FDA1, and I expect to see the number of new specialty drugs continue to increase rapidly. When these drugs hit the market, we won’t have the advantage of historic data to predict how they will perform, for whom, and under what conditions.
This is a particularly daunting scenario since it will only be a matter of time before the predictable outcomes required of other providers through value based care will be expected of specialty pharmacy. Without the ability to prove a value-based outcome, income will be limited for specialty pharmacy.
1. Change the way complex patients are supported
Providing Last Mile Care, or care between provider visits, has long been a huge and expensive gap in the care continuum.
Consider Amy, a 35-year-old who suffers from primary immune deficiency, which causes persistent infections. She self-administers immunoglobulin SQ (SCIG) every 1 to 2 weeks. If Amy’s temperature and white blood cell count are not closely monitored, a serious infection may occur. Improper medication handling and injection techniques have landed Amy in the ER more than once.
Amy knows she needs to follow the instructions of her medication regimen, but she must read through complicated paper instructions for multiple drugs including the SCIG. She often struggles to understand what order things should be done in. Her immune deficiency makes it hard to concentrate and she often forgets to chart her temperatures and injections. If she can’t connect with her provider quickly when she has questions or is experiencing unexpected side effects, she goes right to the emergency room.
Additionally, Hizentra, the SCIG she uses, has only been on the market for a short time. There is limited knowledge about best practices for its delivery. Amy’s insurance is concerned that her specialty pharmacy has too many patients like Amy, whose care is more expensive than other patients in the same population.
Mobile apps designed to bridge the last mile can empower patients like Amy and improve outcomes. Apps can turn care plans into simple daily tasks, making it easy to follow treatment-specific instructions, exchange secure messages with a care team, and read educational content.
The same apps can also be used to track side effects and gather biometric data. This last-mile patient data can help care managers direct their attention where it’s needed most, enabling “just-in-time” interventions that improve outcomes and reduce costs.
2. Improve outcomes by collecting data and improving visibility
However, personalized mobile care plans will have limited potential if they aren’t supported by robust backend technology that aggregates patient data at scale. That data also needs to be accessible to all parties involved in the delivery of care. It will be up to specialty pharmacies to extract insights from this data and, through a process of continual improvement, redefine operations across the entire value chain.
In particular, the specialty pharmacy industry should celebrate the opportunity to provide data back to manufacturers. This has the potential to impact and accelerate drug research and development, while reducing side effects for already vulnerable and suffering populations. Well utilized, this data should improve outcomes for the specialty industry, patients and payors, creating a trifecta of value for those who are poised to capitalize.
Is specialty pharmacy up to the challenge?
It certainly can’t be done without technology. While there are a number of care coordination platforms and mobile apps on the market, integrating with the complex systems and workflows that are already in place is a significant challenge that has prevented wide-scale adoption.
Diplomat, the nation’s largest independent specialty pharmacy, is one example of a company thoughtfully applying technology to innovate. I recently spoke to Susan Faust, VP of Payor Strategies at Diplomat, about their recent initiative to provide last-mile care to patients through AllMetrx.
“By providing tools that empower patients and caregivers to take a more active role in their care and treatment, AllMetrx has the potential to become a go-to solution for managing chronic illness, reducing readmissions and unnecessary doctor visits,” she said. “We now have the transparency we needed to be able to extract insights from the services we provide for patients. The platform’s data handling and reporting capabilities make it possible for us to deliver value for our prescribers, payor partners and pharma manufacturers.”
Diplomat’s care management initiative, AllMetrx, is powered by Patient IO. According to Jason Bornhorst, Patient IO’s CEO, “We take the complexity out of care coordination at scale. We’re not just an app - we’re an infrastructure for delivering last mile care. We integrate with any existing workflow and provide actionable insights every step of the way.”
Technologies that provide last mile care at scale will disrupting the way specialty pharmacy, patients and payors interact. This will be increasingly important for specialty pharmacy in a value-based health care landscape.
1 Specialty Drug Approvals : 2015 Highlights and 2016 Projections. Michigan: Diplomat Clinical Services. 2015. PDF.