Health System Specialty Pharmacies Can Drive Value-Based Care With Data Collection

The number of health system specialty pharmacies (HSSPs) is not only growing, but HSSPs are evolving to a higher level of complexity. This evolution has gotten specialty pharmacists integrated at the point of care so they can provide quality care, said panelists at Asembia's 15th annual Specialty Pharmacy Summit, held April 29 to May 2 in Las Vegas. The panel was hosted by AmerisourceBergen’s Integrated Health Systems Outcomes Coalition.

Payers are looking at how specialty drugs are a growing part of total budgets, now accounting for 40%, and they are looking how to manage that growing spend, such as through narrow networks or vertical integration, explained Diane Giaquinta, president, StrategiCare. They might also consider what to do from an access perspective, such as putting in place prior authorization or step therapy or implementing site of care strategies.

“I think, overall, the response is a heightened management on specialty and only getting more heightened going forward,” she said.

And the amount of care delivered by specialty pharmacies is only going to grow, said Champ Burgess, vice president pharmacy ventures, University Hospitals Health System. What sets apart specialty pharmacies, though, is the full concierge, white-glove service they can provide for patients.

When a patient gets a new prescription for a specialty drug, it can be one of the worst moments in that patient’s life. They are getting a new diagnosis with a treatment that can help or cure them, but is very expensive. Specialty pharmacies try to help alleviate the stress with that high level of care, Burgess said.

Data from these HSSPs is vital for the manufacturers, said Tom Koenig, executive director biosimilar market access, Boehringer Ingelheim; and Elizabeth Forner, director of national oncology pathway strategy, Eisai.

“When a manufacture gives access to a high-priced specialty oral therapy to a health system, that prescription goes into a black hole,” Forner said.

The manufacturer is looking to know how well that product is doing and if it performs as well as in the clinical trial or if the patients are adherent and what adverse events they are facing. Having that data in an electronic health record (EHR) is of great interest to manufacturers.

In addition, that data in the EHR could lead to faster time to therapy for patients, and that transparency is also important, said Koenig.

According to Giaquinta, the data that health systems have access to in their EHRs can also answer questions like:

1. Is this the right patient for the drug?
2. Is the patient adherent?
3. Is the patient continuing to derive benefit? Should they stay on the therapy?

Data such as whether the drug keeps the patient in good health or prevents further decline are important for outcomes contracts, but soft data points can also be important to understand. For example, showing that the HSSP can alleviate anxiety and fear patients have when they start on their cancer journey, said Forner.

Koenig admits that the idea of using soft data points doesn’t really sound good from the manufacturer’s perspective, but for certain diseases states that are progressive, hard data points are not going to be impressive.

“…Some of these softer data points actually might be able to show, comparatively, benefit of being on your drug long term versus not,” he said. “Soft data points for certain disease states actually have very great value and can help actually justify the value of a product…”

From a payer perspective, soft data points that show that patients and providers are satisfied are a way to track operational efficiencies. If they’re happy, there has been less interaction with the system, and that interaction has been pain-free, said Giaquinta.

All the panelists agreed that there has been to alignment between the various sectors of healthcare in order to successfully use data to encourage growth of value-based care.

“Manufacturers, payers, and pharma have to come to the table and agree on what’s best for patients,” Burgess said.