Data-Driven Insights

Specialty Pharmacy Status/Sub-Status Analysis Highlights Inconsistencies in Data Quality

March 21, 2017   |   Brandon Underwood

A Sneak Peek at our Upcoming Benchmark Report

Manufacturers contract with specialty pharmacies to provide a variety of services. One of these contracted services is data reporting on status/sub-status combinations.

These status/sub-status combinations can be mapped to explain in great detail the steps taken by patient, provider, and pharmacist from therapy initiation through therapy completion/cancellation/discontinuation – a process known as the patient journey.

In the course of developing Specialty Analytics, a joint offering of IntegriChain and ProMetrics, we grew to suspect that the quality and granularity of status/sub-status data being reported to manufacturers varied considerably by brand, therapeutic category, specialty pharmacy, and specialty pharmacy class of trade.

We set out to investigate that hypothesis.

In partnership with ProMetrics, IntegriChain examined the quality and granularity of status/sub-status data across 40 specialty pharmacies representing different classes of trade (small independent, mid-sized payer, large PBM, etc.). The records we combed through included 15 specialty brands in five therapeutic categories: Immunology, Hematology, Virology, Oncology, and Pulmonary/Respiratory. Overall, IntegriChain and ProMetrics analyzed more than 657,000 sub-status records reported in Q4 2016. The brands we studied had comparable status/sub-status reporting requirements.

Specialty Pharmacy Benchmark Report Available
The full results of our status/sub-status analysis will be part of the IntegriChain-ProMetrics Specialty Pharmacy Benchmark Report. The benchmark report is available at the 2017 Asembia Specialty Pharmacy Summit.

Interested in a free copy of the IntegriChain-ProMetrics Specialty Pharmacy Benchmark Report?

The full report details how the mix of status/sub-status data reporting breaks down across therapeutic categories and classes of specialty pharmacy. Inconsistencies found in the data suggest that opportunities exist for brands to adopt best practices for active management. Overuse of certain status/sub-status combinations such as Pending – Other, which is the primary focus of this post, is but one of many examples of inconsistencies in data reporting dealt with in the full report where data quality can improve.

Here’s a sneak peek at our findings.

Is there an opportunity to improve the quality of data reported by specialty pharmacies?
In short, yes. A prime example of a status/sub-status combination that doesn’t provide the level of insight manufacturers need to properly evaluate network performance is Pending – Other, which relates to new patient enrollments where the prescription has yet to be filled for the first time or cancelled.

Specialty Pharmacy Status/Sub-Status Analysis

Upon examining more than 196,000 Pending status records across 40 specialty pharmacies, our analysis shows that the Other sub-status accounted for 23% of the total records reported.

Does sub-status reporting vary by brand at the same specialty pharmacy?
Holding constant for a single specialty pharmacy (large Pharmacy Benefit Manager (PBM)-owned), we can see the variance in sub-status reporting across the 15 specialty brands in our study. While the Pending – Other status/sub-status combination was 23% of the total, the percentage varied significantly from brand to brand. At the low end, three brands received Pending – Other as a status/sub-status combination less than 1% of the time.

Conversely, two brands’ Pending – Other status/sub-status counts added up to more than 40% of the reported records.

The inconsistent use of the Pending – Other status/sub-status combination across brands at the same specialty pharmacy points to a few possibilities.

  1. Nuances of a brand’s data model are not properly being captured when being mapped to specialty pharmacy system
  2. Individual records are not being appropriately coded

Given the similar reporting requirements noted at the top of this post, it is reasonable to conclude that brands registering less than 1% of Pending – Other status/sub-status combinations are more actively managing data reporting in collaboration with the specialty pharmacy, and in turn, receiving more meaningful data.

Does the use of the Pending – Other status/sub-status combination vary by therapeutic category?
The data analysis conducted by IntegriChain and ProMetrics for this section includes four therapeutic categories: Immunology, Virology, Oncology, and Pulmonary/Respiratory. Again, there was a wide berth as it relates to use of the Pending – Other status/sub-status combination. Forty-seven percent of records in the Virology therapeutic category were reported as Pending – Other.

At the opposite end of the spectrum, the Pending – Other status/sub-status combination accounted for roughly 16% of the records in the Pulmonary/Respiratory therapeutic category.

These samples from the forthcoming IntegriChain-ProMetrics Specialty Pharmacy Benchmark Report show the inconsistency in data quality and granularity being reported to manufacturers. These findings also pose a larger question to manufacturers – do you know enough about the records you are receiving to have confidence in your data?

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