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

Perhaps the most important component of value-based care is performance measurement, the authors wrote. To be competitive in today’s market, pharmacies must tie their interventions to positive patient outcomes, according to the study.
 
Adherence measures have become a hallmark of a specialty pharmacy’s value, as this can mitigate hospitalization and other avoidable costs. While adherence to complex treatments can present a unique challenge for each patient, specialty pharmacies have implemented effective strategies, including integrated refill reminds and care management programs.
 
“That’s what makes specialty pharmacies so vital,” Green said. “They’re not just managing the drug, they’re managing the whole process. The pharmacist connects with the patient and the pharmacy collects the resulting data, analyzes it and makes it actionable so that it can inform future efforts.”
 
Adding the “Sixth Right” to the mix highlights the importance of patient outcomes and value-based care, according to the report. Without the right result, the costly medication can be deemed unnecessary, resulting in waste. This principle is central to URAC’s Specialty Pharmacy Accreditation program.
 
“The high-price of specialty pharmaceuticals and the potential impact on patient safety requires specialty pharmacies to have specific competencies for tracking how patients respond to a drug therapy and ensuring patients have the appropriate outcome,” Green said.
 
Achieving the right result is crucial for promoting optimal outcomes, preventing hospitalization, and reducing costs, URAC reported. Specialty drugs require substantial coordination between various health care providers, with pharmacists providing crucial education and monitoring throughout therapy. The shift away from fee-for-service reimbursement reinforces the importance of specialty pharmacist involvement in an episode of care.
 
Additionally, since many PBMs and health plans primarily partner with pharmacies that have a proven record of beneficial outcomes, accreditation has become a necessity. Accreditation allows stakeholders to see that a certain pharmacy consistently meets high standards set by the program.
 
Even as therapeutic options for multiple sclerosis, cancer, and rheumatoid arthritis continue to dominate the market, orphan drugs may also account for a significant share of the market in the future, according to the study.
 
Orphan drugs coming to the market provides an additional opportunity for specialty pharmacies to set themselves apart from the competition through developing and sustaining clinical, logistical, and operational practices for small patient populations with complex diseases.
 
This expansive growth in specialty will continue to attract more players, which makes staying competitive especially important. Payers will likely continue the trend of seeking only accredited pharmacies that have demonstrated their value. Pharmacies that are accredited and patient-centered will be the best positioned to gain business, the report concluded.
 
“Pharmacy practice is undergoing a transformation: from an operational focus to providing more value-based services. This is a positive trend for patients as well as the industry,” says Heather Bonome, URAC’s director of pharmacy. “URAC understands what’s necessary to make this transition, and our accreditation program facilitates the process.”


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