Specialty Pharmacy Trends Call for Innovation

Specialty pharmacies serve as a hub of services for all stakeholders, offering comprehensive support programs for patients and data-driven clinical intelligence for providers and payers.

Specialty pharmacies play a central role in meeting the challenges—and opportunities—of today’s pharmacy health care business. Currently, the industry faces escalating medication costs, a robust pipeline inclusive of orphan medications and oral blockbusters, and a growing number of limited-distribution medications. Specialty pharmacies are well positioned to serve as a hub of services caring for patients while connecting providers, health plans, and employers with the services they need. These groups count on us, and we share the same goals: better health outcomes, reduced costs, and improvement of the lives of our patients.

Delivering Cost-Effective Patient Care Models

As the industry prepares for market expansion, health plans and employers have become acutely aware of their specialty spend and are interested in opportunities to manage costs. Plans and employers realize that specialty pharmacies play a pivotal role in helping to meet the challenge of rising specialty costs and specialized patient care. Patient-centric models of care deliver on patient, employer, and plan needs by minimizing waste, dispensing medication according to clinically appropriate guidelines, and providing start-of-therapy medication consultation and pharmacist-led regimen check points to monitor response to therapy. The patient support, follow-up, and monitoring provided by these services are important parts of cost-reduction strategies. If we are to succeed in cutting costs, we need patient-centric approaches that solve some of the predictable and recurring problems of clinical care.

Here’s one. Despite the benefits and escalating use of oral oncology treatment regimens, managing this treatment also comes with new challenges. Patients take the medication at home where they are not under the watchful eye of clinicians, and they are more likely to take it incorrectly or stop altogether because they can’t tolerate the side effects. The Walgreens Oral Oncology Cycle Management Program is helping to solve this problem by bridging the oversight gap, putting specialty pharmacy clinicians in regular contact with patients to identify side effects as they emerge, and working with the patient’s physician to manage side effects as quickly as possible.

With new prescriptions, patients receive a split-fill, only a half-month’s worth of medication, rather than a full month’s worth. If side effects are manageable, the patient receives the remaining portion; if they are too burdensome, the patient’s therapy is adjusted. This vigilant, high-touch dose management approach greatly improves adherence and reduces medication waste, saving payers an average of more than $934 per patient.¹

Infusion therapy is another area where there’s potentially a simple fix. By shifting infusion therapy from a hospital outpatient department to an alternative treatment site, such as an infusion center or the patient’s home, the cost per infusion per patient can be reduced by as much as 60%.²

Improving Outcomes and Managing Spend Through Clinical Data Insights

When you can show in black and white the degree of savings a program or service can offer, providers and health plans pay attention. They are eager for data-driven clinical intelligence that can help them improve patient outcomes and manage costs—all the more so as quality indicators are being built into reimbursement.

Walgreens has retooled its clinical insights reporting to provide payers with patient- and employer-level data dashboards that can be used to assess cost per quarter, total cost to date, and overall specialty medication trends. Access to micro trends through reporting greatly enhances the ability of payers and employers to understand the drivers of trend and forecast future risk. We also have a dedicated clinical team that provides important insights into medications that are coming on the market as potential alternative or replacement therapies.

Understanding the cost benefit and competitive advantage of a new medication is important in our business as the pipeline continues to expand. Eight of the top 10 medications by revenue—and half of the top 100 medications—are expected to be specialty medications by 2016.² Of particular interest is the proliferation of orphan and limited distribution drugs.

Managing Orphan and Limited Distribution Medications

Orphan drugs present a unique challenge for specialty pharmacies because they affect 200,000 or fewer patients with rare disease states that often had little or no treatment precedent. We’re addressing this with considerable success by working with manufacturers to establish access to medications and providing specific pharmacist training on the new medications, so that pharmacists can help patients manage potential side effects and encourage medication adherence. Beyond access to medications and one-on-one relationships with knowledgeable pharmacists, we’ve also built in a variety of support services for these patients with rare diseases by working with advocacy groups that support patients with rare chronic conditions.

The collaborations we pursue are tailored to the disease and the specific needs of patients. For example, Walgreens has formed an alliance with the Cystic Fibrosis Foundation and has an ownership stake in the foundation’s specialty pharmacy, Cystic Fibrosis Services, Inc. Cystic fibrosis (CF) patients now have greater access to affordable medications and high-quality expanded services through Walgreens national network of pharmacies, and the foundation has been able to expand its patient assistance and advocacy programs. We are working together to develop innovative programs that can help CF patients better manage their treatment and receive individualized care.

Individualized care is the core of the Walgreens approach to comprehensive pharmacy services. The Walgreens network is built on a model of disease-state expertise and a system that allows us to monitor and respond to patients in real time. This system also allows us to become an extension of the patient’s health care team.

Specialty pharmacy providers can and do fill the gaps in care. When a patient leaves the doctor’s office or hospital and returns home, it is pharmacists who are best positioned to monitor medication therapy and help ensure that patients are adhering to prescribed therapy. Pharmacists are also well positioned to provide a seamless transition in care and give regular updates to the physician. We can truly become partners in patient care.

Supporting Patients with Comprehensive Pharmacy Services

Walgreens has developed more than a dozen clinical management programs for diseases and conditions ranging from CF, hepatitis C, and cancer to rheumatoid arthritis and bleeding disorders. Each program is backed by a team of pharmacists and supportive health care providers who received specialized training in their disease area. We dispense medication, of course, but our role encompasses a whole patient view, offering access to financial support, assistance with health plan authorizations, disease counseling, and a face-to-face relationship that extends years beyond a patient’s initial diagnosis.

Moving Forward

All told, these trends and our ability to address them—particularly in light of the growing number of Americans with chronic and complex conditions who will have access to care based on the provisions of the Affordable Care Act—underscore the reality of the specialty pharmacy as a critical service hub. Exceptional care will ultimately be determined by how our businesses anticipate and respond as we provide a seamless specialty pharmacy experience for all our stakeholders. Regardless of the direction the future takes, we must continue to rely on the core tenet of exceptional individualized patient care. SPT

References

• Walgreens data on file.
• Walgreens data on file.

About the Author

Donald J. Vidic, RPh, MBA, vice president of specialty operations and pharmacy services at Walgreens Specialty Pharmacy, has been with the company since December 2008. In his current role, Don is responsible for the central specialty pharmacy assets of Walgreens Specialty Pharmacy. Immediately prior to joining Walgreens, Don was vice president and general manager of the McKesson Specialty Pharmacy. He began his tenure with McKesson as vice president of operations.

Adding to his more than 20 years of specialty pharmacy experience, Don spent 4 years as the senior director of operations for Medco Specialty Services, where he built the first dedicated specialty operation and was ultimately responsible for the Accredo joint operations partnership, until its eventual acquisition.

Don received his Bachelor of Science in pharmacy from the University of Pittsburgh and his Master of Business Administration from Waynesburg University.