Hospitals and health systems of all sizes, take note: Specialty medications – those high-cost drugs used to treat complex or chronic diagnoses – are expected to represent more than 50 percent of the overall drug market within five years.
Oncology medications alone account for one-third of specialty drugs. Other therapeutic classes include hepatitis C, HIV, multiple sclerosis, infertility, transplantation medications and others. Looking ahead, approximately 80 percent of future drug approvals are expected to fall in the specialty category. With so much activity in this space, experts advise hospitals and health systems to assess their participation opportunities now.
“We believe that health systems offering outpatient specialty pharmacy services are setting the new standard of patient care. Health systems are best equipped to provide timely access to medications while improving patient care coordination,” said George Zula, vice president at Acentrus Specialty. “In this setting, patients can get quicker access to life-saving medication. In many cases, health system specialty pharmacies are able to complete prior authorizations within one or two days.”
Health systems’ use of electronic health records (EHR) also contributes to patients receiving their medications faster, as well as lower abandonment rates and improved outcomes to prescribed specialty products.
"The unique capabilities of health systems' specialty pharmacies provide greater satisfaction to patients and providers," said Chris Hatwig, MS, RPh, FASHP, president of Apexus. "Being a client of the Acentrus program provides hospitals and health systems access to the Acentrus portfolio, which enables the building or expansion of their specialty offering."
Exploring your options in specialty pharmacy
A common misconception is that health system ambulatory pharmacies cannot manage specialty patients, however the reality is that most specialty pharmacy services can be performed out of a hospital’s existing ambulatory pharmacy. Hospitals may choose to add specialty pharmacy capabilities on their own or work with channel partners to enhance specialty services.
Zula suggested that hospitals with ambulatory pharmacies start small. “Assess your current operations. If you want to get into specialty, begin with therapeutic areas that you already serve. Maybe it is oncology drugs or transplant medications. Then determine which additional services you could perform on your own and those that may require channel partners. If a specialty program is more established, you may want to complete an opportunity assessment to determine current and future patient volumes.”
It is also important to know that a hospital with an ambulatory pharmacy may begin or expand specialty services without items often touted as necessities, like additional technology, a state-of-the-art call center or significant capital/FTEs. By narrowing the focus to specialty drugs already provided or to those determined to be feasible, a hospital may get into specialty more quickly and easily than first anticipated.
Before putting any specialty plan into action, a hospital or health system should take time to understand current market conditions.
“Manufacturers often limit distribution of specialty medications to restricted networks,” Zula said. “Sometimes there is little or no competition in a therapeutic category, so they know they can limit distribution to whom they want, which lowers inventory and distribution costs. Other times, they’re limiting distribution to retain access to utilization data, including dispense data, case management and medical information for patients prescribed their specialty product. On the other side, payer networks and PBMs that manage pharmacy benefits don’t want to give up prescriptions. But the restricted access can reduce the level of care to patients.”
Looking at it another way, the reduced level of care and lack of coordination creates a prime opportunity for hospitals and health systems to assess their specialty pharmacy capabilities and areas for growth.
“Think about the risks to future patients’ continuity of care without your involvement in specialty pharmacy,” Zula said. “By waiting and watching, you may lose patients to other channels with established ambulatory/specialty pharmacies. There may be an inability to participate in specialty pharmacy networks as conditions change over time, and there may be a loss of significant opportunity and access to new, limited-distribution drugs. In the long term, there may even be a potential risk to your health system’s viability.”
Begin now to educate your hospital’s leadership about quality-of-care improvements, growth potential and the projected risks and rewards of specialty pharmacy. It will be time well spent.