The IntegriChain team will be attending the Armada Specialty Pharmacy Summit & Expo next week in Las Vegas, NV. With specialty pharmacy at the forefront of our minds, we have asked Jason Bogroff, Principal Consultant at Blue Fin Group, to share with us his insights into specialty pharmacy, including emerging pharmacy models and implications of specialty data.

Jason is a sought after expert in translating technical complexity and ambiguity into innovative tactics and executable plans. He is recognized for his creative excellence in applying his combination of business and technical acumen to customer needs that span the breadth of Healthcare commerce. Blue Fin Group customers’ have mined significant value as Jason applies his outstanding project management skills and deep methodology understanding across the areas of channel and customer operations, forecasting, planning and replenishment, channel data and analytics, enterprise technology, logistics and engineering, product and service design and development, and business process design and optimization.

Within Blue Fin Group in 2013 we watched the rapid evolution of healthcare in the US with rapt attention. The winds of change are blowing hard on our industry and will likely drive changes in pharmacy models and create data “opportunities” for manufacturers. These changes will occur, and are already occurring, within high-cost diseases and their specialty therapies.

Emerging Pharmacy Models

Because this is a blog post, I don’t have the freedom to painstakingly paint a portrait of the industry drivers of change, the reactions of payers and providers, and the new care delivery models that are emerging. Essentially the net of it is that consolidation, integration and coordination along the continuum of patient care are necessary for providers to be accountable for outcomes, cost and quality of care. Figure 1 below is a Blue Fin Group summary of these change drivers and provider reactions.

Will these dramatic changes also encompass the dispensing and use of medicines? We believe the answer is yes, because “throwing scripts over the wall” into wide-open pharmacy does not support accountability for outcomes, cost and quality of care. Consolidation, integration and coordination along the continuum of patient care within integrated networks (IDN/IHN) and accountable care organizations (ACO) must include dispensing and use of medicines, and three integrated pharmacy models are already emerging to accomplish this:

1. A fully-owned and controlled pharmacy model, including brick and mortar community pharmacy, mail order pharmacy, specialty pharmacy, home infusion, infusion suites and even patient services.
2. An owned and controlled patient medication therapy management (MTM) function, which manages dispensing and utilization within a preferred network of pharmacies.
3. Outsourced management of the “poly-pharmacy” to a third party (e.g. CVS Caremark or Walgreens) that has retail pharmacy, mail order pharmacy, specialty pharmacy, infusion suites, home infusion and patient services.

These pharmacy models are emerging initially for high-cost specialty drugs because they are often associated with high-cost and high risk disease states. These models also emerge whether the provider motivation is optimized patient care or maximized revenue. The important variables for these pharmacy models are integration into the overall continuum of care, influence on the patient experience and access to key drugs, and this is creating a new and powerful lever for gaining access to manufacturer drugs that are in limited pharmacy networks. Coordination along the continuum of care refers to creation and adherence of standards of care and clinical pathways. These pharmacy models will have specific requirements and expectations for having access to the drugs included in their standards of care and clinical pathways. Not too dissimilar from formulary control, this will be a new lever used to influence pricing and gain access to limited pharmacy networks.

Implications for Specialty Data

If managing data for a limited network of 15-20 specialty pharmacies is challenging today, consider how that will be impacted with another 15-20 IDN/IHN SPP’s and ACO SPP’s as part of that network. Manufacturers will need smart data requirements that are directly linked to thorough data management and business utilization use cases. They will need to know which elements are mandatory for support of critical business processes. Focus on and scrutiny of typical specialty channel performance metrics like Time to Fill, Medication Possession Ratio and Time on Therapy will continue to increase. Manufacturers will need to broaden their data scope beyond just dispense data to also include prescription status. Statuses such as Pending, Denied, Hold, Cancelled and Discontinued are critical for ensuring that Time to Fill, MPR and Time on Therapy measurement results are relevant and actionable. There are many valid reasons for a prescription delay or stoppage, and they need to be identified and filtered out of the prescription efficiency measurements.

Manufacturers will need to ensure patient longitudinal integrity while also staying compliant with privay and security requirements. This could mean shifting the definition of data intermediaries to become pharmacy business associates and changing the location of application of de-identification algorithms in the overall data flow to enable limited pharmacy networks composed of more diverse companies with very different data capabilities.

Manufacturers of specialty drugs have significantly evolved their specialty channel and data capabilities and sophistication in the past 3-5 years. The takeaway from this article should be that the rate of industry change will continue and will likely increase, so manufacturers will need to respond with flexibility and adaptability to ensure continued business alignment and compliance.

Tags: Specialty Pharmacy