What Differentiates Effective Core Services from Enhanced Services in Specialty Pharmacy?

Specialty pharmacies have multiple decisions to make for clinical programs that accompany a contract with a manufacturer.

In contracting with drug manufacturers, specialty pharmacies have a variety of decisions to make regarding their offerings and clinical programs. Typically, manufacturers first provide a request for proposal to each interested specialty pharmacy who may be equipped to handle their business.

A section of the proposal should include the data and information services that a specialty pharmacy would agree to provide to the drug manufacturer. A separate section would explain the clinical services that the pharmacy would provide to the patient. These services can be considered either core or enhanced Services.

In considering data and information services that a pharmacy would provide to its drug manufacturer, a pharmacy can determine whether it will offer core or enhanced services. Basic core services would include NDC numbers, prescriber NPI numbers, and de-identified patient demographic information.

In general, most manufacturers will receive these core services, and pharmacies are typically expected to provide them. These core services benefit manufacturers, because they allow the company to predict sales, manage inventory, and target prescribers whose patients would benefit from the product.

Beyond these core services, a pharmacy can propose to offer enhanced services. Enhanced services could include extra, pertinent clinical information, such as lab values. This benefits manufacturers because it provides enhanced support of their post-marketing, phase 4 data reporting required by the FDA.

For example, if a drug is metabolized through the liver, it would benefit the drug company to have results from a liver function test, both prior to and following the therapy. Having hard data would certainly assist the manufacturer in fine-tuning the parameters for initiating and remaining on therapy.

Pharmacies benefit from offering enhanced services because they profit from the extra fees associated with the sale of information. Also, offering enhanced services helps to differentiate from competitors.

Some specialty pharmacies either cannot or will not offer enhanced services, in some cases. In that event, a competitor pharmacy who does offer the enhanced service may have the upper hand.

In considering clinical services, a specialty pharmacy can also determine whether to offer core or enhanced services to patients. Basic core services would include patient communication, medication usage monitoring, financial assistance and benefits investigation.

These core services allow patients to adhere to their prescribed therapy and realize the benefits of the medication. Most patients have come to expect this level of services, as they often rely upon health care providers to openly communicate medical advice, answer questions, or respond to concerns while in the office.

Beyond the core services, specialty pharmacies could also offer their patients more enhanced services. Enhanced services may include communication via text messaging or online video chatting services, such as Skype.

Further, enhanced services for clinical patients could include closer monitoring of drug inventory in the patient home through use of advanced technologies. Patients would benefit from this type of services because they would be provided with a more personalized approach to their drug therapy management.

Often, patients with a more customized or user-friendly experience show better adherence to their treatment, and therefore more positive outcomes. This benefits the patient, health care provider, and the drug manufacturer in important ways.

However, there are down sides to offering enhanced services. Enhanced services cost more for the specialty pharmacies to provide, as they require adjustments to the workflow and deviations from the standard operating procedures.

For example, a specialty pharmacy that offers online live video consultations would incur costs to pay for the software, to train their staff in using the software, and may have to incur costs to ensure that the patients have access to software. While the benefit could be great overall, the up-front costs and costs of maintaining the services could deter some specialty pharmacies for offering that amenity.

In choosing to offer core or enhanced services, pharmacies must be professional and clear in the way that they categorize their offerings. One pharmacy’s core service could be considered an enhanced service if no other pharmacy offers it.

In that case, a third-party consultant would provide a fair-market evaluation of the service to determine whether or not it could be considered core or enhanced. In another case, a pharmacy who attempts offer a service to everyone, but bills a higher amount to only some clients for identical services, could be liable for losing future contracts.

Clearly, specialty pharmacies must be cautious and precise in determining what offerings fall under core or enhanced services for both their manufacturers and patients. Moreover, as the industry progresses, specialty pharmacies must continue to advance their offerings, as the standard for what was once considered an enhanced becomes a core service.

The bar will continually rise and specialty pharmacies must innovate and drive progress forward.

About the Author

John Meehan earned his PharmD degree from Duquesne University in 2010. John worked in retail pharmacy in rural North Carolina before transitioning to a clinical pharmacist position at Chartwell PA in Pittsburgh, PA. John 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.