NASP President Discusses the Role of Specialty Pharmacy in the Health Care Ecosystem

In a 2-part Q&A with Specialty Pharmacy Times, NASP President Rebecca Shanahan discussed how direct and indirect remuneration (DIR) fees affect specialty pharmacy, how to improve patient outcomes, the impact of Any Willing Provider legislation on payer access and patient services, and many other hot topics in the specialty landscape.
Click here to read part 1 of the interview. 

SPT: What is the role of ACOs, GPOs, or individual institutions in specialty pharmacy?

Shanahan: We think ACOs are an interesting concept. We believe that specialty pharmacy is a uniquely positioned service model to be successful with an ACO because specialty pharmacy really is a connector amongst health care providers for specific disease states, and so we think that we become knowledgeable partners. Today, we are highly integrated with both hospitals and doctors, both doctors who are affiliated with hospitals by virtue of an employment agreement or who are affiliated by virtue of their participation on the hospital’s medical staff. We really fit hand and glove with doctors and doctor’s offices, regardless of their affiliation, if they’re in a hospital affiliated clinic or if they’re in an independent clinic, we fit hand in glove with them relative to keeping that patient on therapy and keeping track of that patient. We also coordinate not only the clinical coordination and the pharmacy coordination, but also all of the paperwork that needs to happen.

We know that we provide value, so when a patient transitions either out of the hospital into their home, or transition out of an inpatient setting into a home setting, then we know that we are the folks that provide the support as the patient goes into their home. We also know that readmissions for conditions that are treated by specialty pharmacies can be high, and that by virtue of how specialty pharmacies manage these complex and chronic conditions, including our ongoing communication with the patient care team in the hospital and in the doctor’s office, that we are in fact assuring clinical outcomes in a way that that’s very holistic for the patient, and I think that’s what a ACO model is intended to do. In addition, there are currently doctors and hospitals that require either compounded medications and/or services with respect to specialty pharmaceuticals as a part of their care model. We are tightly integrated with these hospitals, outpatient centers, and doctors to ensure that all of the pharmaceutical products these folks require for their patients are provided in the highest quality, lowest cost, most appropriate setting. So, 47% of total specialty medical costs are provided in an outpatient setting, another 40% in a physician’s office, and 9% at the patient’s home, and we have a reach and a partnership into all those platforms for purposes of managing outcomes.

SPT: How providing specialty pharmacy services smooths the transition from inpatient hospital pharmacy to outpatient specialty pharmacy?

Shanahan: For many pharmacies who have relationships with hospitals, there is a coordination of the meds that are going to be provided at the discharge of a patient. They’re going to transition from that brick and mortar care that’s very immediate, into a situation where there’s not a lot of immediacy if they don’t have a coordinator of care. We would generally identify medications that are specialty drugs that are going to need to be provided to that patient in their home. We would either go to the hospital or we would arrange for the hospital to have the package of medication for the patient when they get discharged from the hospital. We then counsel the patient with respect to those medications, ensure that they have the medications when they arrive at their home, initiate a conversation with those patients and their families as they arrive home, and call the patient back after they receive their medication to be sure they’ve gotten it, that they understand the intervals during which they’re supposed to take it, where they need to store it––in the refrigerator if it’s refrigerated medication— how they need to take it in terms of times of the day––with water without water, with other food without other food––and we follow up based on how we assess the patients’ capability of managing themselves at regular intervals to check to see have they been taking their pills, and if they have taken the right dose at the right time. Interestingly enough, even if they’re taking a dose every day, if they’re taking 1 dose at 8 o’clock in the morning, and the next day taking the same medication at 4 o’clock in the afternoon, they’re likely to get less optimal results out of those therapies. So we’re constantly intervening with them to be sure that they are adhering to their therapy, adhering to it at the right dose and the right time, and with the right results.

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