Evaluation of Specialty Pharmacy in an Integrated Health-System Emma Chermely, PharmD, BCACP Alyssa McCann, PharmD, BCACP *The presenters have no conflicts of interest to disclose.
Objectives Introduce the background of specialty pharmacy Evaluate UC Health s Specialty Pharmacy patient population and services Describe the impact a specialty pharmacy can have within a health-system Describe the various role for pharmacy technicians within a specialty pharmacy*. * Technician Learning objective
What is a specialty pharmacy? State-licensed pharmacies that solely or largely provide only medications for serious complex health conditions Connect severely ill patients with disease specific high cost, high touch medications Provide patient care services Support patients through reimbursement challenges Excellent services drive adherence and ensure appropriate medication use The National Association of Specialty Pharmacy. NASP Definitions of Specialty Pharmacy and Specialty Medications (Feb 2016). http:////naspnet.org/wpcontent/uploads/2017/02/nasp-defintions-final-2.16.pdf (accessed 25 Mar 2018). M Goldenhorn, R Smith, PT Rocafort. Understanding the high-touch model. Getting acquainted with specialty pharmacy (Mar 2014). ACPE CE. www.freece.com/freece/cecatalog_details.aspx?id=9a3f14ab-c000-4655-a4a8-c425a2d2b3de (accessed 25 Mar 2018).
What are specialty medications? Medications that require intensive patient management May require special handling, storage and/or administration May be administered orally, subcutaneously, or intravenously May cost up to $750,000 per year Require comprehensive patient care, clinical management, and product support services The National Association of Specialty Pharmacy. NASP Definitions of Specialty Pharmacy and Specialty Medications (Feb 2016). http:////naspnet.org/wpcontent/uploads/2017/02/nasp-defintions-final-2.16.pdf (accessed 25 Mar 2018). M Goldenhorn, R Smith, PT Rocafort. Understanding the high-touch model. Getting acquainted with specialty pharmacy (Mar 2014). ACPE CE. www.freece.com/freece/cecatalog_details.aspx?id=9a3f14ab-c000-4655-a4a8-c425a2d2b3de (accessed 25 Mar 2018).
Impact of Specialty Medications AJPB Top 5 Medications Humira Harvoni Enbrel Rituxan Remicade AJHP Top 5 Medications Humira Lantus Harvoni Enbrel Remicade Spending on specialty medications doubled from 2010 to 2015 Specialty medications contributed 70% to overall growth of drug expenditures Toich L. Top 5 highest-selling drugs of 2016. AJPB (Aug 2017) www.ajbp.com/news/top-5-highestselling-drugs-of-2016 (accessed 25 Mar 2018) Shumock et al. National trends in prescription drug expenditures and projections for 2017. AJHP (May 2017). www.ajhp/org/content/early/2017/05/17/ajhp170164/tab-figures-data (accessed 2018 Mar 25) IMS Institute for Healthcare Informatics. Medicines use and spending in the U.S. A review of 2015 and outlook to 2020 (April 2016). www. imshealth.com/en/thoughtleadership/quintilesims-institute/reports/ medicines-use-and-spending-in-the-us-a-review-of-2015-and-outlook-to-2020 (accessed 2018 Mar 25).
Growth of Specialty Pharmacies Figure 1. Pharmacy Locations with Specialty Pharmacy Accreditation by Corporate Ownership 2015 vs 2016 CAGR: compound annual growth rate Figure 2. Pharmacy Industry Prescription Revenue ($ Billions) Steiber, Dan. Proving value in specialty pharmacy practice: a new yardstick. AJPB (Nov/Dec 2017). www.ajpb.com/journals/ajpb/2017/ajpb_novemberdecember2017/provingvalue-in-specialty-pharmacy-practice-a-new-yardstick (accessed 25 Mar 2018).
Health-System Specialty Models University of Utah Health Care Implemented in 2014 Added 8 technician FTE and 1 pharmacist FTE Goals: 1. Develop centralized prior authorization (PA) process 2. Develop a call center to provide specialty pharmacy services 3. Utilize Electronic Medical Record (EMR) documentation Program Results 137% increase in specialty pharmacy revenue in fiscal year 2015 Average PA approval time of 3 business days Excluded cases involving denials or appeals Rim M. Am J Health Syst Pharm. 2016 Jun 1; 73(11):831-8.
Health-System Specialty Models Vanderbilt Specialty Pharmacy 20 specialty clinics 24 clinical pharmacists and 20 technicians Specialty pharmacists and technicians work from clinic Services are tailored to individual clinic Basic Services Patient counseling Benefits Investigating/Prior Authorization Financial counseling Refill reminder calls 24-hour on-call pharmacist Free shipping Customizable Services Assist in medication selection Lab monitoring Collaborative Practice Agreement Adherence monitoring REMS program management Independent pharmacist clinic visits Bagwell A. J Manag Care Spec Pharm, 2017 Aug; 23(8):815-820.
UC Health Specialty Pharmacy Opened in October 2016 Obtained URAC Accreditation in July 2017 Staffing: 4.5 pharmacists and 2 technicians Service lines covered Solid Organ Transplant Oncology/Hematology Infectious Diseases Gastroenterology Neurology (Multiple Sclerosis) Cardiology
UC Health Specialty Pharmacy Workflow Technician Technician xx Benefits Investigation xx Initiate Prior Authorization xx Approved Document Document Document Uninsured xxmedication Access Referral Z Insured xx Denied High Copay Z Dispense or Transfer Technician Technician Document
UC Health Specialty Pharmacy Workflow Initial Assessment Refill Call Routine Assessment
UC Health Specialty Pharmacy TherigySTM utilized as patient management system Not integrated with Epic Cloud-based product that contains: Patient demographics Therapeutic category Medication Prior authorization information Various activities Medication refills, clinical assessments, clinical interventions
Patients UC Health Specialty Pharmacy Patients 500 450 400 350 300 250 200 150 100 50 0 HCV HIV Hem/Onc Transplant Other Disease State Total 1,189 Patients
Transplant Type Patients by Transplant Type Transplant Service started in October 2015 1 pharmacist Coordinate, fill, and ship all medications for patient Initial and quarterly assessment If > 3 years from transplant, annual assessments Recent study showed improved Proportion of Days Covered (PDC) with specialty pharmacy 88% to 97% (p<0.001) Pancreas Kidney/Pancreas Kidney/Liver Liver Kidney Heart/Kidney Heart 0 20 40 60 80 100 120 140 160 Patients
Human Immunodeficiency Virus (HIV) Service rapidly expanded in January 2018 469 Active Patients 1.5 Clinical Pharmacists 1 Technician
Hepatitis C (HCV) 143 Active Patients 1 Clinical Pharmacist Prior Authorization (PA) turnaround time of 4 business days Month Total Prior Authorizations Prescriptions filled at Specialty January 33 14 February 32 14
Hematology/Oncology 134 Active Patients 16 Hematology 118 Oncology 1 Clinical Pharmacist PA turnaround time of 2 business days Month Total Prior Authorizations Prescriptions filled at Specialty January 28 12 February 27 14
Additional Benefits of an Integrated Specialty Pharmacy Decreased fragmentation Coordinated care within one health-system Utilization of patient s medical record for communication Improved access to medication for patients Increased patient and provider satisfaction
UC Health Medication Access Services Operate with 1 Coordinator and 6 Advocates Highly integrated within UC Health Assist patients and providers with Review and Verification of Insurance Coverage Insurance Benefit Selection Medicare Part D and Medicare Extra Help Diagnosis-specific Foundation Assistance Pharmaceutical-specific Co-pay Assistance Pharmaceutical-specific Patient Assistance Programs 30% of specialty patients utilize these services
Revenue Number of Patients $180,000.00 $160,000.00 $140,000.00 $120,000.00 $100,000.00 $80,000.00 $60,000.00 $40,000.00 $20,000.00 $- Specialty Pharmacy Revenue from Medication Access Services January February March April May June July August September October November December January Month 200 180 160 140 120 100 80 60 40 20 0 Number of Patients Revenue
Cost Avoidance Number of Patients $250,000.00 $200,000.00 Specialty Pharmacy Cost Avoidance from Medication Access Services 45 40 35 $150,000.00 $100,000.00 $50,000.00 30 25 20 15 10 5 $- January February March April May June July August September October November December January Month 0 Cost Avoidance Number of Patients
UC Health Specialty Pharmacy Quality Management Satisfaction surveys conducted quarterly Utilizes a 5 point Likert scale Overall satisfaction of 4.87 and 4.91 for providers and patients Majority of patients received medications via mail Lowest score was affordability of medications 97.3% of patients would recommend UC Health Specialty Pharmacy 91.3% of providers would strongly recommend UC Health Specialty Pharmacy to colleagues
UC Health Specialty Pharmacy Growth *Includes data through 1/31/18
UC Health Specialty Pharmacy Growth *Includes data through 1/31/18
UC Health Specialty Pharmacy Barriers to Care Patient population Limited access to medications Medication cost Pharmacy Benefit Manager (PBM) restrictions Ohio is not an any willing provider state
UC Health Specialty Pharmacy Future Directions Increase staffing Individualized roles for pharmacy technicians Expansion to more specialty clinics Increase access to medications Incorporation of the 4 P s Patient Providers Pharma Payers
Active Learning #1 According to AJPB and AJHP, what was the top selling specialty medication in 2016? A. Imbruvica B. Harvoni C. Prograf D. Humira
Active Learning #2 What are the 4 P s of Specialty Pharmacy? A. Patient, Product, Providers, Pharmacy B. Patient, Product, Pharma, Payers C. Patient, Providers, Pharma, Payers D. Patient, Providers, Pharmacy, Payers
Evaluation of Specialty Pharmacy in an Integrated Health-System Emma Chermely, PharmD, BCACP Alyssa McCann, PharmD, BCACP *The presenters have no conflicts of interest to disclose.