Specialty Pharmacies Must be Value-Driven, Patient-Centric to Remain Competitive

The high number of specialty drugs emerging into the marketplace has increased competition among independent pharmacies and chain pharmacies. As the health care industry moves towards value-based reimbursement, health plans, pharmacy benefit managers (PBMs), physicians, and hospitals are looking to partner with pharmacies that have proven the ability to deliver high-value care at a low cost, according a new white paper from URAC.
 
To engage in competition, specialty pharmacies must create a sustainable way to improve processes, while also gathering and sharing data that highlights their ability to improve adherence and outcomes.
 
Continuously measuring and improving performance adds another piece to the “Five Rights” of medication distribution (the right patient, the right drug, the right dose, the right route, and the right time): the “Sixth Right,” the right result, according to the study.
 
“Pharmacists and pharmacies have evolved from playing supporting roles to being vital leaders in managing patient care and improving outcomes,” said Kylanne Green, URAC’s president and CEO.
 
It is no secret that the specialty pharmacy industry has boomed in the past 5 years, partially influenced by a plateau of generic drug use, increased utilization of specialty drugs, and a vast developmental pipeline. As more drugs are approved, the amount of PBMs, retail chains, health plans, wholesalers, physicians, hospital systems, and independent specialty pharmacies are all competing to sell the same drugs, according to the report.
 
Specialty pharmacies are now facing market pressure to move towards value-based care. Since the complicated treatment regimens are costly and require management services, payers require PBMs to manage utilization and reimbursement. PBMs trust accredited specialty pharmacies to focus on adherence and patient outcomes for optimal cost control.
 
“The need for managing patient care throughout the course of therapy will never be greater,” Green said. “Pharmacists and pharmacies that begin to adopt fundamental elements of the new value economy, those who position themselves as an essential part of the care team, will succeed.”
 
Recently, value-based reimbursement under Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was revised to change how providers are paid for patient outcomes, which places an emphasis on improving overall care, according to the report. This has significant implications for specialty pharmacy competition.
 
“Physicians are care team leaders under MACRA,” Green said. “If physicians benefit financially by partnering with top-performing pharmacies who help them improve quality, they will seek them out.”
 
To ensure that they are viewed as a valuable member of the care team, pharmacists must have a vast understanding of complex disease states, which includes making therapeutic recommendations and collaborating with other providers to demonstrate their value, according to the report.
 
“Pharmacists and pharmacies who can demonstrate their ability to manage medication and thus demonstrate their value will be recruited by accountable care organizations, clinically integrated networks and patient-centered medical homes,” Green said. “Pharmacists will no longer play supporting roles. They will be vital leads.”
 


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