Removing Barriers to Treatment and Breaking Down Siloes in Specialty Care

Ryan Nix, PharmD, MMHC

Image credit: Vanderbilt University Medical Center

Specialty care often faces multiple barriers that can prevent patients from getting on or staying on therapy, said Ryan Nix, PharmD, MMHC, senior director of operations, Vanderbilt Specialty Pharmacy.

In an interview with The American Journal of Managed Care® (AJMC®) at the 2024 Asembia Specialty Pharmacy Summit earlier this year, Nix also discussed breaking down the walls in care, creating a patient experience of care that is holistically managed, and the experience at Vanderbilt’s integrated delivery network.

AJMC: As specialty medications can be complex and require special handling, what is the role of the specialty pharmacy within a health system to ensure patients initiate treatment and adhere to it?

Nix: So, say any specialty pharmacy, right? That's the whole point of why you call something specialty because there are barriers that are going to come into play that may prevent a patient from either being able to get on therapy or to stay on therapy. Any specialty pharmacy is probably going to have different adherence tools. How do I reach out to patients? How do I have proactive communication with patients? Helping to assist with financial assistance is a key component of being a specialty pharmacy. But I think the health system perspective is that in addition to doing that, you're not just helping with prior authorizations but having access to the emergency department really allows for you to actually do the prior authorization. You can fully handle that and take care of it. Get all of the information. You can assist with appeal letters. That's the additional functionality. I think that you really see with these groups.

Our specialty pharmacy, we've got an embedded pharmacist who works right in the provider’s office. We have actually expanded even from a clinical perspective, where we have pharmacists who are practicing within collaborative practice agreements. This not only allows them to help manage their specialty but also do full comprehensive medication management. No longer are we waiting on sending to a provider saying, “Hey, you're due for labs. Let's get that scheduled.” But the pharmacist can actually have a conversation with the patient, go over where their labs can be done, and they can actually place that order for the lab to make sure we're eliminating that many more barriers that may prevent a patient from staying on their therapy.

AJMC: Siloed care has been an issue for decades in the United States. What remains the challenge with creating true collaborative care?

Nix: Honestly, I think getting around sort of the niceties that we try to play. We try to have conversations: how can we collaborate better, what better ways can we share patient data between places to truly make patient care more effective and collaborative? Sometimes we just have a hard time having those open conversations. What do you need from a manufacturer side? What are you trying to get to make sure that your patients stay compliant—they stay on your therapies longer, and they're more persistent?

From a health system standpoint, trying to understand: how do health systems operate? We've seen plans where folks have rolled out financial assistance models that don't make a lot of sense in current state. We can be a lot more collaborative in our conversations with external stakeholders and really work a lot better as a team so that we're communicating. “These are the problems that we're having. These are the challenges that we go through.” I think that open communication really is going to be the key to getting us outside of those silos and operating more as a team, and really improving patient outcomes.

AJMC: What does the actual patient experience and journey look like when they are managed holistically with an integrated delivery network?

Nix: Your journey tends to be a lot more comprehensive when you're managed within a health-system specialty pharmacy. We've got pharmacists, and if you ask that pharmacist, they're not going to tell you, “I work for the specialty pharmacy.” They're kind of this half mix where they work for the provider, and really, that's their goal: how do we improve patient outcomes? How do we get the best for patients?

We know that our specialty pharmacy is not going to be able to fill for every single patient. There are different payer network challenges. There are manufacturer challenges with limited distribution networks. But having a pharmacist in that clinic and working with these medications means that they are going to manage those patients regardless of what pharmacy they're going to. If patients are required to go to some big box specialty pharmacy outside of the health system, our pharmacists are still managing that. They're still following up on lab work. They're still participating in these collaborative practice agreements and managing all of those patient steps. I think that's the real difference between a health system approach and the approach of sending them to outside groups.