Specialist home pharmacy services are gaining popularity in hospitals and health systems looking to drive efficiency in their operations and improve profitability.
Most of the new treatments approved by the U.S. Food and Drug Administration in the last few years are specialty drugs, high-cost treatments used for complex conditions. As of early 2021, the FDA has approved nearly 80 specific drugs to treat conditions ranging from plaque psoriasis to metastatic melanoma.
Health systems are up and running, supplementing specialty pharmacy operations or maintaining existing operations to increase revenue and generate potential cost savings for patients and providers service. Many systems treat the initial financing costs and other challenges as a long-term investment.
“It really allows the health system to take that patient in, when they present with an initial diagnosis or during an acute inpatient visit, and make sure that these drugs are the ones that really matter. very sensitive, high cost, high risk, said David Chen, assistant vice president of pharmacy planning and leadership at the American Association of Hospital Pharmacists.
According to a survey of the society, about 26% of hospitals were operating pharmacy departments in 2019, compared with about 8% in 2015.
Streamline operations
Healthcare leaders say demand is growing.
Charles McCluskey, vice president of pharmacy services at OhioHealth based in Columbus.
Once integrated into the system, specialist pharmacists can review lab results, report any changes in disease status, and cycle drug therapies more quickly.
UConn Health in Farmington, Connecticut, set up its own specialty pharmacy in 2020. Kevin Chamberlin, interim assistant vice president and director of pharmacy, says it’s an effective way to avoid patient leaks – when patients go out of the hospital system to get the services they need.
“If you have a patient who has to go outside of your network and can go to another provider to get access to these drugs and they get good service, they are more likely to seek out services. Other can be offered to them from the said Chamberlin. “If we lose patients because of this, how can we lose them from our system?”
Integrative specialty pharmacy also generates a predictable revenue stream for the hospital system. They can monitor patient needs for certain treatments and have more control over when patients will receive their medications, rather than relying on a third-party process that can take weeks. Most specialty drugs are dispensed via mail order, but some systems maintain a direct facility for patients to receive prescriptions.
UConn Health nearly doubled its net sales from specialty pharmaceuticals from fiscal year 2021-2022, filling more than 11,000 prescriptions, Chamberlin said.
Some health systems established specialty in-house pharmacies years ago and continue to see benefits.
At New York-based Northwell Health, the specialty pharmacy was established in 2012 to streamline care for HIV patients. The system places an on-site pharmacist at an HIV clinic and creates a referral plan for doctors. Onisis Stefas, director of pharmacy, says the team has seen a significant improvement in the patients’ viral loads, as these patients have more stable access to the medications they need with support at the hospital. home.
Northwell’s team of specialist pharmacists, which extend into the areas of oncology and rheumatology, says Stefas, serve as an important focal point between patient visits. The team works with patients to develop plans of care, help them find financial assistance programs, and contact them regularly to discuss their medications.
The potential for cost savings, such as avoiding urgent care, is especially important for hospitals that treat people at risk, says Stefan.
“The dollars we generate through the pharmacy are then reinvested back into the organization and many times in the form of community benefits.[s]”includes COVID testing, vaccinations, health clinics, food delivery in the community,” he said.
Hospitals can also save some costs if a particular drug is eligible for the 340B Drug Pricing Program, which requires drug manufacturers to sell the drug at a discounted price to health care systems. care for uninsured or low-income patients. Matt Conway, commercial director at Shields Health Solutions, says manufacturers can work with hospitals to bring more innovative treatments to market.
Significant challenges
Chamberlin of UConn Health says setting up an in-house specialty pharmacy is an expensive and arduous undertaking.
Hospital systems must collect data to better demonstrate outcomes to pharmaceutical companies before gaining full access to a drug — a process that often takes up to two years, McCluskey said. Insurers also want to see certifications before partnering with new specialty pharmacies, Chamberlin adds.
Practical barriers to entry – such as making sure there is enough storage space and equipment to keep medications at the right temperature.
Then there are the political branches.
Health systems do not have access to a limited number of drugs, which means manufacturers have restricted access to some pharmacies. Pharmacy benefit managers often have their own specialty pharmacies, directing that patient’s revenue toward them rather than to an outside pharmacy. OhioHealth decided to open its specialty pharmacy after changing its PBM and now includes those services as part of its health plan network, McCluskey said.
Hospital groups have also denounced white-packing – an agreement between payers and some pharmacies that choose to send drugs directly to care sites for providers to prepare – saying it affects hospital safety checks and may delay patient care. Payers and PBMs argue that this delivery model can be more cost-effective, potentially saving patients.
Last year, Arkansas, Louisiana and Virginia passed laws against this practice. Several other states are also considering similar measures.
“There is high competition in the field of expertise,” says McCluskey. “Ultimately, when you decide that it is something you want to do or need to do, you jump into a space where there are many rules and barriers to success.”
