Specialty Pharmacy: Build, Buy, or Partner

Dan Duffy

The use of oral oncolytics is rapidly expanding, giving patients promising new treatment options. In 2015, nine oral cancer drugs were approved by the FDA, and of the 836 cancer medicines and vaccines biopharmaceutical companies currently have in clinical development, 25% are oral agents.

Every oncology practice operates with the same mission: to provide the best patient care possible. Yet, that care is not delivered in a vacuum. Today, oncology practices are faced with reform initiatives and market challenges that create gaps in their ability to manage patient care, ensure patient access to medication, and succeed in a value-based care environment. Consequently, oncology practices often turn to specialty pharmacies to gain access to vital oncolytics and for help in filling these gaps. Oncologists need a pharmacy provider with extensive therapeutic expertise and experience in oncology that will support their treatment plans and alleviate their administrative burden so that they can focus on treating patients. They want a pharmacy provider with the skill, expertise, and resources to understand and help manage the clinical, financial, and emotional complexities associated with cancer treatment.

Buy: this offers many of the same benefits of building your capabilities and may accelerate the process and limit diversion of focus; however, it requires significant upfront capital.

Build: this requires a significant investment of time and resources, but allows practices to maintain control. Questions to consider: do you have the expertise to build from scratch? Will this divert attention from higher priorities?

Partner: practices enter a symbiotic relationship based on aligned goals. Partnerships are generally a faster way to add services and capabilities and require fewer upfront resources; however, they involve compromise, with both partners relinquishing some control.

Specialty Pharmacy Partnerships Are Not all Alike

For oncology practices that want to expand specialty pharmacy services on behalf of their patients, should they build, buy, or partner?For health system-based oncology practices or large national oncology practice networks, build and buy are viable options; whereas, for most community practices, partnerships may offer the fastest, most cost-effective method to expand their specialty pharmacy capabilities and create value for their patients.Specialty pharmacy partnerships can take a number of forms, such as working with an independent specialty pharmacy in the same community or a regional pharmacy provider that specializes in therapeutic classes that match the practice’s patient mix. Oncology practices can also look to small technology or consulting companies that can help address specific functions, such as prior authorization, medication reconciliation, or patient support and education.

Another option is to work with a full service provider that not only provides access to drugs but also strives to become a valued member of the provider’s care team. Such a full-service provider may have similar patient outcome goals, deep therapeutic expertise in cancer care, and a wealth of patient-centric services to drive better outcomes.

Patient Access and Practice Management Support

Regardless of which form your specialty pharmacy partnership takes, the ultimate goal should be to protect the long-term viability of your oncology practice by helping it to become more efficient and more profitable.One of the primary reasons oncology practices first turn to specialty pharmacies is to gain access to the lifesaving drugs that are vital for their patients. Drug manufacturers often restrict distribution to specific channels, blocking access for the practice’s in-office dispensing pharmacy. Even if the drug can be obtained by the practice, getting payment can be difficult, as payer-approved pharmacy networks are often very restrictive.

There are also financial barriers associated with oral cancer medications that can create both access and adherence issues. According to Biologics research, nearly 20% of new patients participate in manufacturer payment support programs or receive financial assistance for their medications. Many patients, especially those in late-stage therapy, have already had a difficult journey, both physically and financially. It’s very beneficial to have a pharmacy provider that stays current with manufacturer or nonprofit patient-assistance programs, changing regulations, and enrollment processes and can help patients to solve financial issues.

Specialty Pharmacy Can Offer Management Assistance

Patient onboarding, prior authorizations, medication benefit investigation, and resolution are critical administrative tasks that ensure patients have access to the treatments they need and the practice is paid properly. However, these tasks are a significant burden for oncology practices. Look for specialty pharmacy partners that provide comprehensive practice management resources that help practices run more efficiently, so that your staff can focus on delivering high-quality patient care.As the market continues to shift to value-based care and payment, community oncology practices must increasingly look at reducing costs, improving quality, and reporting performance metrics. Specialty pharmacy partnerships can help oncology practices effectively and efficiently manage critical patient needs with a high-touch/high-care multidisciplinary operating model.

Practices have primary responsibility for patient care; however, specialty pharmacies can help manage clinical complexities such as educating patients on how to take their medications properly, controlling side effects, helping patients deal with late-stage therapies, and managing other intricacies that affect patients.

Harnessing Data for Better Clinical Outcomes

Under some forms of value-based care, practices are responsible for outcomes and the cost of care, which often includes many costs that originate outside the practice, such an emergency department visit for a rash or dehydration. A full-service specialty pharmacy with a patient contact who has the ability to handle both clinical and nonclinical conversations is able to provide patient support around the clock. Oncology certified nurses and board-certified oncology pharmacists who specialize in blood and solid tumors provide deep therapeutic expertise and support. These professionals can provide oncology patients assistance when it is needed and then communicate the event back to the practice for inclusion in the patient’s electronic health record. This offers a tremendous opportunity for quality patient care, a positive patient experience, and cost containment.The ability to capture, track, and report accurate, timely data is highly valuable to all stakeholders in the oncology community. Specialty pharmacy has broad and deep analytic capabilities, which support operational and clinical efficiencies and high-quality care. Additionally, pharmacy data management and performance reporting capabilities help provide quality care and collect business intelligence to support sound decision making while building a strong foundation for the transition to value-based care.

The Right Partner Can Make the Difference

It is critical for oncology practices to adopt advanced analytics as payers increasingly base payments on outcomes. Data can reveal different treatment options, help with the choice of the best option, enable providers to stay apprised of the latest clinical trials, and identify patients eligible for those trials. Data could show the practice how its care compares with national benchmarks, accepted clinical protocols, and evidence-based standards. The data could uncover any inconsistencies or variations in care and provide direction on how to improve.The solution to tapping into this data is finding the right partner. That partner could be another oncology practice or a related medical specialty practice willing to share and process data for analytical purposes. That partner could be an oncology data analytics technology vendor that can provide both the scale and the expertise that small practices need. Or, that partner could be a payer willing to subsidize the cost of the technology and expertise in exchange for insights on how to achieve the best possible clinical outcomes for cancer patients at the lowest possible cost.

Specialty pharmacies are part of an ecosystem of excellence. In this ecosystem, the oncology practice is the expert in all of the different components necessary to deliver quality care, and all components are aligned to achieve optimal outcomes. The specialty pharmacy is not an island unto itself, but rather a part of the ecosystem that delivers the highest level of care possible to the patient. Its part in this ecosystem is to go beyond the typical role of a specialty pharmacy, becoming a valuable resource to help manage the clinical, financial, and emotional complexities associated with cancer care.

Egerton NJ. In-office dispensing of oral oncolytics: a continuity of care and cost mitigation model for cancer patients. Am J Manag Care. 2016. http://www.ajmc.com/journals/supplement/2016/improving-patient-access-to-critical-therapies- in-the-age-of-cost-sharing/in-office-dispensing-of-oral-oncolytics-a-continuity- of-care-and-cost-mitigation-model-for-cancer-patients. Accessed November 3, 2016.