Specialty pharmacies need to maintain services that ensure optimal patient care and outcomes.
There are 2 important stakeholders when it comes to specialty medications: the patients and the providers. Both groups have a vested interest in the clinical outcome.
Specialty pharmacy was founded on "white glove" service, in which both patients and providers expect each prescription to be handled with the utmost care. To fully understand a patient's specialty experience, we must frequently ask ourselves, “what would I expect if I were a specialty patient or a specialized provider?”
What would you expect if you were diagnosed with a specialty condition? First of all, would you ask yourself, “what exactly is a specialty condition, and what exactly defines specialty?”
Many times the answer to this question is life-changing and terrifying for patients. Cancer, rheumatoid arthritis, and HIV, are just a few of the life-changing conditions that fall under this umbrella.
Once the reality of the condition begins to set in, then the needed medication must be started to improve clinical outcomes. How would the ideal specialty pharmacy interact with both the patient and their provider?
The ideal specialty pharmacy would have clear upfront communication with both parties. Proactive communication and referral management for the provider would allow the specialist to know precisely what services and capabilities the specialty pharmacy provides.
The provider then could inform the newly diagnosed patient that, although the condition may seem scary, their expertise, and that of the specialty pharmacy, will ensure the best possible clinical outcomes. At this point, the referral has been sent to the specialty pharmacy, and the patient's interaction with the specialty pharmacy begins.
A true specialty pharmacy must first build a relationship with each of their patients, only asking for a credit card and mailing address will not improve outcomes. The specialty pharmacy should be set up to provide a single-point-of-contact (SPOC) for the patient to guide them through their therapy.
This SPOC could ensure proactive financial services, as opposed to just offering services once the copay is too high for the patient’s income. This initial financial review can soften the blow of many therapies due to the high cost.
The SPOC can be allied in the fight against most of these diseases, and be a supporting pillar of the clinical team. Often, the patient will provide additional information about their care to someone they trust. The SPOC can partially fill this role.
Some specialty treatments are so complex that the team members employed by the specialty pharmacy cannot perform all of their necessary roles solely with excellent customer service. They have to utilize advancements in technology, as well.
The specialty pharmacy must invest in technology that will aid their patients on their road to successful outcomes. Simply placing refill reminder calls, as with an IVR system, will not suffice. The system must allow for gaps to be proactively closed to optimize patient care.
Ensuring patients have another prescription ready when their refills run out is a common example, therefore system flags or reports must be able to provide this information. Many therapies require routine lab monitoring or patient surveys; thus, the pharmacy system must make this information easy to track and aid the providers.
The specialty pharmacists or team members frequently serve as a safety net for providers. And often remind offices of necessary steps during the treatment process.
A vital role the specialty pharmacy provides for providers, and the patients themselves, is a common location for their medication history. This medical record is often the most complete out of any of the patient's providers, and allows for drug utilization reviews to screen for improper therapies.
This step is vital to ensure that every therapy is the most appropriate and cost effective for the patient. This leads to a topic that most patients and providers dread: the cost of treatment.
Despite your best customer service, novel pharmacy system, and drug expertise, the most common question asked is, “what is this therapy going to cost?”
Some patients are fortunate to have insurance that will cover the majority of their medication; however, a significant portion are not so lucky. The ability of a specialty pharmacy to reduce the financial burden of a patient can play a vital role in clinical outcomes. If a patient cannot afford their therapy, then it does not matter how great the specialist was, or how cutting edge the technology was.
Patients will only take treatments they can afford, and that is the bottom line. Financial situations change drastically from one patient to the next, so making assumptions about a patient's ability to pay will often lead to poorer outcomes. A $100 copay may fit well into one patient's budget, but to another, that may lead to sacrificing some basic needs of life.
Specialty pharmacies hold a unique foothold within the health care arena, and are vital to optimizing patient care. Their customer services skills often can make the difference in a patient's ability and desire to be compliant to their therapies. The subtle difference of knowing the name of a patient's pet, or where they like to vacation, often can make a significant difference in their compliance.
Reducing a patient's cost can often make the difference for their entire family's financial situation. Overall, specialty pharmacy needs to maintain the "white glove" service it was founded upon to ensure optimal patient care and outcomes.
About the Author
Anthony Mazzarese is a graduate of The University of Pittsburgh School of Pharmacy 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 is the Pharmacist-In-Charge at Giant Eagle Specialty Pharmacy. His practice is focused on improving medication compliance and overall wellbeing in the areas of HIV, auto-immune disorders, oncology, and organ transplantation.