Accessible Community-Based Care Is Key for Specialty Pharma

Specialty pharmaceuticals continue to be one of the fastest-growing classes of medications, representing 36 percent of total pharmacy revenue—a new high for the industry1. Treating patients with complex diseases is inherently challenging, and as the upward trajectory of specialty drugs continues, community-based specialty pharmacies are ideal channels for providing the high-touch patient care that is essential to keeping costs down and patients on therapy.

As an industry working towards the shared goal of positive health outcomes, we must ensure patients can access the medications they need in a setting they trust, whether that is the specialty pharmacy at the health system down the street, in their provider’s office, or through an independent mail-order specialty pharmacy. But narrowing payor networks have created challenges for various pharmacies to get access to the specialty drugs their patients need. To overcome these obstacles, community-based specialty pharmacies need to leverage data-driven strategies to help expand their access to contracts and break down barriers for patients.

Eliminating Barriers to Patient Care

First, specialty pharmacies must leverage powerful data to demonstrate their value to payors and open access to critical medications. Health system specialty pharmacies (HSSPs), for instance, benefit from electronic health records access and the ability to directly engage with the physician, enabling enhanced care coordination, expedited prescription dispensing, and an improved patient experience. Furthermore, frequent touch points between the patient and HSSP create opportunities to ask questions, share concerns, and build trust, which contribute to better patient adherence. A strong adherence rate is critical for payors to consider as it can be tied to fewer adverse events or trips to the emergency room, and ultimately a lower total cost of care. At the same time, collaborative practice agreements can help strengthen pharmacies’ value proposition by authorizing them to deliver specific patient care services such as drug therapy management.

Pharmacies also have their own metrics, including prescription and claims data, capture rates, therapy compliance, and satisfaction that are essential in helping communicate their individual value story. Specialty Pharmacy Services Administration Organizations (PSAO) can be critical partners in pulling the right data and value story together to help expand a member pharmacy’s access to specialty contracts with payors and pharmacy benefit managers.

Breaking Through to Payors

In addition to representing pharmacies in negotiations with payors, specialty PSAOs can also help take the burden off pharmacies and allow them to focus on what matters most: their patients. By utilizing comprehensive pharmacy data, technology, and professional services, specialty PSAOs can help pharmacies navigate the intricacies of managed care networks through professional services that improve operational efficiency, minimize profit leakage, and maximize commercial prescription capture opportunities.

As more specialty products continue to come to market, it’s more important than ever that we allow patients to access the care they need, where they need it. It’s time to unlock the value of specialty medications and community-based care at a national scale.

1. Drug Channels. The 2020 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. March 2020. https://drugchannelsinstitute.com/files/2020-PharmacyPBM-DCI-Overview.pdf