Specialty Pharmacy: The Big Picture and Why You Should Care
Jul 24, 2014 - 1:50:28 PM
Accompanied by prior authorization and financial assistance - Due to their elaborate delivery and higher expense, specialty pharmaceutical prescriptions usually require prior authorization from insurance providers and are placed in a higher tier. Manufacturers sometimes provide financial assistance via rebates and coupons to patients requesting filled scripts.
Delivered with special handling - Many specialty meds require constant refrigeration, infusion delivery, express or overnight shipping, or other unique handling.
Distributed via limited channels - Due to the special handling or the unique patient monitoring that accompanies some drugs, with some specialty pharmaceuticals only a few pharmacies are given the approval to dispense the drug.
Prescribed by a specialist - Oncologists, dermatologists, gastroenterologists and other specialists stay up to date with these unique drug therapies and prescribe them to their patients with chronic and serious health conditions.
Monitored closely throughout treatment - Manufacturers of specialty pharmaceuticals work closely with specialty pharmacies to ensure patients receive adequate education, monitoring, disease maintenance care and more.
Already a $127 billion market, specialty pharmacy is expected to represent $235 billion by 2018, or 50% of all US pharma spend. Is it right for your hospital?
In terms of opportunities for improved patient care and enhanced revenue, hospital systems are uniquely positioned to enter the specialty market. You already have relationships with the specialists prescribing these specialty pharmaceuticals. Together, you are deeply invested in retaining the care of your patients within your system. Many of your peers cringe at the notion that providing the patient the care s/he needs requires sending the patient to another entity. Also, patients may struggle to get the prior authorizations and refills they so desperately need, as they typically lack in-depth understanding of a payer's processes and are already struggling with a life-changing illness.
If your facility is interested in bringing your specialty pharmacy needs in-house, know that facilities that do so typically:
Have an existing outpatient pharmacy space, a plan to develop one or a recognized need for one.
Have prescribers within their system currently writing scripts for specialty drugs, and those scripts are being filled outside the system.
o These specialists are treating patients for neurological disorders, oncology, rheumatoid arthritis, hepatitis C, HIV/AIDS and/or multiple sclerosis, as these disease states represent the highest spend categories in the specialty pharmacy arena.
o Facilities successfully entering the specialty space have a plan in place to work with these specialists, ensuring they know they can keep the care within the system. Crafting a specific internal communication strategy will reduce the time required for effective ROI.
Are self-insured or have their own health plans.
Have a home health division, an ambulatory infusion center and/or an infusion clinic, all of which are likely treating patients using specialty medications.
Joining a specialty drug network can be a critical component of your future growth plans. By expanding the scope of your outpatient pharmacy (where the majority of specialty drugs are administered), you can:
retain patients and win new patients
help patients access new specialty treatment options
integrate accountable care practices
Best of all, not only does this process improve patient care but it can create a significant revenue stream for the hospital.
Gary Freeman is responsible for the efficient day-to-day operations, strategies and performance of Amerinet’s Pharmacy Division.
With over 30 years of healthcare experience, Freeman served more than eight years as the director of the pharmacy program for AllHealth, a regional group purchasing organization serving the Mid-Atlantic states prior to joining Amerinet in April 2006. He has significant hospital experience, serving as the pharmacy director in three different hospitals in the Philadelphia, Pa., region.
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