Over the last few years, more hospitals and health systems across the country are realizing the advantage of working with a partner focused on accelerating the growth of their specialty pharmacy. A specialty pharmacy partner helps build or strengthen an existing specialty pharmacy program, improve access to care and manage the complex medication needs of patient populations. In doing so, they help hospitals and health systems create new revenue opportunities with a healthier bottom line.
Medication nonadherence costs over $670 billion annually, resulting in 12 million hospitalizations and more than 275,000 deaths. When a hospital or health system opens their own specialty pharmacy, or expands an existing specialty pharmacy program, the dispensing of complex medications evolves and becomes a strategic, innovative and patient focused service across the organization. This evolution allows access and care to become optimized. As a result, access to specialty medications improve, increasing adherence and keeping patients healthy, while also contributing to decreased hospitalizations. Adherence is dependent on a patient’s ability to easily access, afford and understand their medication. A high-touch approach to specialty pharmacy removes the barriers to adherence and improves a patient’s health and overall experience.
Implementing a specialty pharmacy strategy and approach for growth not only creates a revenue stream for the system, but also establishes a high-touch patient engagement program that becomes a differentiator in the way service is delivered for their community.
Prescription drugs are one of the largest categories of spend for healthcare systems and is noted as the fastest growing segment for the next five years and beyond, as referenced by the American Hospital Association. Specialty medications are the main driver of this trend, with the majority of the growth coming from a small number of high-cost drugs used to treat a small number of patients. Specialty drugs currently represent just under 2% of the total prescriptions, but were 49.4% of the total expenditures on prescription products in 2021, increasing 8.7% compared to 2020. Mail-order pharmacies accounted for $130.3 billion, or 45.7% of the specialty drug spending; clinics, including doctor’s offices and outpatient clinics accounted for $84.2 billion, or 29.5% of the specialty drug spending; and retail pharmacies accounted for $38.5 billion, or 13.5% of all specialty drug spending.
Key players, like CVS, have now added vertical business relationships (or ownership) among insurers, pharmacy benefit managers (PBMs), specialty pharmacies and providers. Strategic expansion of services and influence in order to capture more business and manage the expanding cost portfolio of specialty drugs. When a hospital or health system provides specialty pharmacies services their patients and their system greatly benefit from the clinical, financial and experiential outcomes delivered. All of which are vastly different and variable if the patients receives the services from external entities.
A specialty pharmacy partner helps to identify opportunities for healthcare organizations to leverage their pharmacy, and if applicable, the 340B program to expand services to patients in their communities. For example, a partner can help to create a 340B patient financial assistance program to pass savings directly to patients, helping them to access and afford their specialty medications. This program reduces or removes high co-pays for patients and therefore, improves treatment compliance and medication adherence. In just 18 months, a specialty pharmacy partner program assisted over 400 patients in receiving 2,500+ prescriptions – channeling nearly $3 million toward financial assistance for patients who were prescribed specialty medication therapies.
Partners also help hospitals and health systems succeed by working with drug companies, wholesalers and payers to create savings in their contracts. This includes expanding group purchase access, creating 340B-like savings, forging direct purchasing relationships and negotiating performance-based contracts for rebates.
Finally, prior authorization and medication dispensing turnaround time can be greatly improved through a specialty pharmacy partner. According to the American Medical Association (AMA), prior authorizations are an immense burden for physicians, and cost valuable time. According to an AMA survey, physicians have an average workload of 45 prior authorizations a week, which translates to almost two business days of physician and staff time. The delay in getting patients lifesaving medications can also lead to serious adverse events, hospitalizations or even death. A specialty pharmacy partner can help to greatly reduce this burden and improve prior authorization and medication dispensing turnaround times for the hospital and staff, allowing for improved patient care and engagement time.
Specialty pharmacy partnership within hospitals and health systems are evolving into a strategic and innovative collaboration that can help to improve complex care, find solutions and create a revenue-producing service line for patients and healthcare facilities.
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