May 20, 2021
Members of the SPARx team of experts lead an informative webinar today in partnership with Becker’s Hospital Review. The speakers included: Keith Cook, President of SPARx; Michael Heinrichs, PharmD, MBA, Senior Vice President of Business Development at SPARx; Doug Massey, PharmD, Senior Vice President of Specialty and Ambulatory Pharmacy Services at SPARx; Susan Trieu, Vice President of Trade Relations at SPARx.
The conversation started by covering the outlook of the specialty pharmacy industry. With major growth in the last decade, IQVIA predicts the US pharmaceutical spend for 2021 to be $600 billion, of which 60% will be accounted for by specialty pharmacy drugs. Additionally, in 2020, 83% of all drug approvals were specialty drugs, with the largest category of those belonging to oncology therapies.
Since the industry is continuing to grow, it was highlighted that it is important hospitals and health systems get involved with specialty pharmacy. While there are many benefits, including the economics of the industry, continuity of patient care, risk management, and better outcomes, hospitals ultimately can benefit from a specialty pharmacy to improve patient care. Since many patients already depend on the local hospital or health system to provide them care, it is the logical next step for their organization to also handle specialty care and ensure the transition of care stays inside the hospital instead of being sourced out to large national chains or payor-owned pharmacies.
Doug Massey then spoke on the first three things that will make a specialty pharmacy successful: infrastructure, accreditation, and technology. In order to build a competitive specialty pharmacy, hospitals and health systems should plan for growth. At the infrastructure level this includes: separating retail, specialty, and infusion pharmacies within the organization; allowing the specialty program the necessary space and opportunities to expand; setting up supporting departments such as regulatory, IT, and finance; and creating networks for provider relationships.
Mr. Massey went on to highlight the importance of not only obtaining accreditation, but also maintaining accreditation. While it may take anywhere from 9-18 months or more to obtain accreditation, the processes and standards set up within the pharmacy to reach the point of accreditation must be maintained on a regular basis to be re-accredited and established as a trusted specialty pharmacy. To succeed in obtaining and maintaining accreditation, specialty pharmacies should set up standards in patient management, quality, compliance, and operations/infrastructure. By addressing these key points, pharmacies can adapt to yearly changes in accreditation standards, set up data analytics and validation, measure and prove clinical outcomes, and create new initiatives for program improvement.
Technology, Mr. Massey pointed out, is essential to obtaining success in the specialty pharmacy arena, however, it is oftentimes the last thing to be updated and utilized in the pharmacy. A good specialty pharmacy software should provide interoperability between the patient management program, the hospital’s EHR, and dispensing system. The pharmacy should also utilize technology to communicate digitally with patients and providers, allowing patients to have a level of control over their own therapy journey, and creating more contact between pharmacists and patients. Lastly, pharmacies should use software to store, process, clean, and report on pharmacy data.
Susan Trieu next discussed the last two things that can make a specialty pharmacy successful: access to products and payors. Distribution can be open to any specialty pharmacy, limited, or exclusive to just one or two in the country. Ms. Trieu discussed that manufacturers establish unique criteria to gain access for each limited distribution drug, however, it is most common for specialty pharmacies to need at least the key points discussed earlier: proper infrastructure, accreditation, and technology capabilities to be able begin the process. Centers of excellence (such as centers for one specialty disease state) or direct access to providers, accreditation from more than one accrediting body, and outcomes and patient population data are specific things that manufacturers look for when deciding who to contract with. By focusing on the unique capabilities of your hospital or health system’s specialty pharmacy, your organization can follow through with program initiatives to build a robust pharmacy that will appeal to manufacturers.
Ms. Trieu also highlighted some specialty drugs on the horizon that will likely be approved soon this year and might be in limited distribution. By looking ahead at drugs in the specialty pipeline, your pharmacy can prepare for their arrival in the marketplace. Ms. Trieu pointed out Arimoclomol, an oral drug from Orphazyme that will be used to treat Niemann-Pick Disease. While this is a rarer disease, the treatment also holds promise for use in ALS therapy. Aducanumab is an upcoming infused Alzheimer’s Disease treatment. It is unique in that it is one of the first therapies in over 10 years that will attempt to treat the underlying causes of Alzheimer’s, not just the symptoms. Biogen, the creator of Aducanumab, believes this could be a $10 billion drug in the future. Finally, Teplizumab is an upcoming intravenous Type 1 Diabetes treatment that could prevent or delay the onset of type 1 Diabetes, which could lead to the therapy coming over the specialty landscape.
Finally, Ms. Trieu addressed payor access. Since many payors are vertically integrated and have their own pharmacies, it is important that hospital and health system specialty pharmacies ask themselves if a contract or partnership with the payor will actually benefit the organization. Some payors may not have favorable reimbursement rates or fees, but others might provide a useful partnership since payors do not have one thing that hospitals and health systems do: a compelling story. Hospitals are able to provide a continuum of care, all the way from the physician to the pharmacy, and are able to focus on specific disease states and prove clinical outcomes.
Keith Cook wrapped up by highlighting some success stories of hospitals and health systems building and growing their own specialty pharmacies. He shared how one regional hospital used SPARx’s hub model of retail, ambulatory, and infusion pharmacies to provide a variety of care to their patients which lead to a 50% increase in revenue and a 42% increase in gross margin. In another case study example, he showed how hospitals and health systems can provide patients with lower drug approval turnaround times and provide incentives and the best possible care to local hospital patients. This health network obtained dual accreditation, LDD access to a Multiple Sclerosis product, and saw a 200% increase in revenue. Finally, Mr. Cook showcased a large academic health system that built out a specialty pharmacy, achieved dual accreditation, and utilized a clinical management software to provide financial, operations, and clinical data. This health system was able to access a large payor network and saw a 400% increase in script volume.
Since each hospital and health system is unique, these organizations should play their best hand and use the hospital organization to their benefit as they build a specialty pharmacy and create partnerships with payors and manufacturers. With SPARx, hospitals and health systems can build and grow their specialty pharmacy to achieve greater advancements in patient care and drive new revenue for long-term success.
You can watch the full webinar recording here:
Learn more about SPARx on our website: https://www.cpspharm.com/sparx/solutions/