Dr Ben Urick Compares Value of Medically Integrated Specialty Pharmacies With Mail Order Pharmacies

Ben Urick, PharmD, PhD of Prime Therapeutics compares the value of medically integrated dispensing (MID) specialty pharmacies with that of mail order pharmacies in a video interview on site at AMCP Nexus. Urick discusses the topic at length, as he was a speaker during the session, "Medically Integrated Dispensing Services: Creating Value for Payers and Providers" on October 17.

Urick is a principal health outcomes researcher at Prime Therapeutics, focusing on the role of community pharmacists and the use of secondary data to measure health care quality and spending.

Transcript

How does the value provided by MID specialty pharmacies compare to mail-order pharmacies in terms of clinical outcomes, member experience, and cost-effectiveness?

The value of medically integrated pharmacies can be thought of in a couple of different ways. Key to value is the idea of quality divided by cost. When it comes to quality, if we're thinking about quality for a dispensing channel for specialty medications, quality can be things like time to therapy initiation, quality can also be things like member experience, provider experience, and clinical outcomes.

There's a lot of literature that has looked at medically integrated pharmacies compared to traditional specialty pharmacies, and they find, generally speaking, that medically integrated pharmacies outperform traditional specialty pharmacies on these areas. So, for example, outcomes. Because there is this level of integration between medically integrated pharmacies and their associated providers, that allows the medically integrated pharmacy to have greater therapeutic monitoring for members to really be in touch with members in terms of symptom management to provide that feedback back to the provider, and that can improve clinical outcomes.

Things like adherence can also be improved, again, through this monitoring through this closer relationship between the pharmacy and the patient and the provider network. Member experience or patient experience is oftentimes much better with these integrated pharmacies, and we've actually shown with our medically integrated pharmacy network a 40 percentage point difference in the net promoter score between a medically integrated pharmacy and a traditional specialty pharmacy. So, we've seen with our own data that that is true, and there's also literature to suggest the same.

Finally, provider experience. If you ask any provider at a clinic that has a specialty pharmacy if they prefer to use their own specialty pharmacy or mail-order specialty pharmacy, they're going to prefer to use their own specialty pharmacy. It's simply more convenient for them, it's easier to run a [prior authorization] process through them, they have a greater trust in that relationship, and so providers also prefer that channel.

That's the quality side of things. If we flip things over and consider cost because cost is the other side of the value equation. Costs can be conceptualized in a variety of ways. The most traditional way of thinking about cost with specialty pharmacy is your cost of goods sold, and there are obvious reasons why a traditional pharmacy is used over medically integrated pharmacies for most payers. Again, because of this cost of goods sold you can get greater discounts through a specialty through a traditional specialty pharmacy. If you're creative with their contracting, you can also achieve some discounts on cost of goods sold with your medically integrated pharmacies.

Beyond that, there are important things to consider like waste. So for example, a medically integrated pharmacy if they are looking at the EMR [electronic medical record] and scheduling a refill around an assessment, literature has shown that there can be a waste reduction there, and we—using a measure that we've developed—are also incorporating waste assessment in our network contracts, we can see that there is a lower waste rate with our medically integrated pharmacies than traditional specialty pharmacies.

Beyond that, also in the area of cost, is this idea of total cost of care. If you are providing better care to a member, it then follows that that better care would reduce your future health care spending. We have seen that there is an association between the medically integrated dispensing channel and lower cost of care. We've seen within our data about a 4% lower total cost of care for medically integrated versus a traditional specialty pharmacy, and that is of course meaningful to our payers who are bearing the most of that medical spending risk.