Specialty Pharmacy: How Effective Teamwork Enhances the Patient Journey

Whether it is a first-time fill or a refill, getting a patient their specialty medication requires a coordination of efforts across many internal departments of a specialty pharmacy and, at times, can even extend beyond the reach of the physical walls of a pharmacy. Each member of the specialty pharmacy care team is an essential component to not only delivering appropriate and efficient service but perhaps, more importantly, influencing and ensuring positive outcomes of therapy.

As no two patients’ needs are ever the same, each player in the specialty pharmacy care team provides invaluable expertise that directly contributes to the patient journey. It is with these varying sets of expertise that specialty pharmacy service can be customized to meet the unique needs of each and every patient and maximize their treatment experience.

While harnessing the talents and skills of each individual on our care team, working together and across channels promotes a culture that is patient-focused. By putting the team first instead of the individual, we can use our associates to their fullest potential to ensure every patient gets the attention that they need most.

Addressing Individual Patient Needs

Patients can face a variety of issues upon their first filling of a specialty medication. Additionally, once started on a specialty medication, patients may encounter many hurdles along the way that prevent medication persistence and impede their chances of remaining on therapy.

Whether these barriers are due to financial constraints, accessibility, adverse effects, lack of understanding of the medication or disease state, or issues affecting adherence, staying on therapy can be equally, if not more challenging, than initiating a new medication. Although some obstacles are more complex than others, as the prescription and the patient pass through the phases of filling and dispensing a medication, by assessing the unique needs of each patient, the right care team members can intervene at the right time.

Meet Your Specialty Pharmacy Care Team

Intake/data entry specialists
In the early stages of filling a new medication, the primary goal should be getting the medication to the patient as quickly as possible. Access can be one of the most complicated steps preventing a patient from getting started on therapy.

Intake and data entry specialists play a critical role in starting the specialty pharmacy filling process. Upon receiving the order, the pharmacy must determine whether or not they have access to the medication. If the medication is considered an exclusive or limited distribution medication, the intake process should account for quickly determining whether or not the pharmacy is able to fill the medication.

If the pharmacy is not contracted to fill, intake and data entry specialists are responsible for appropriately triaging the order to the correct pharmacy and communicating this to the patient. If the pharmacy is able to service the patient, intake and data entry specialists need to determine whether the documentation received is complete or is still missing key pieces of information before completing a new referral.

Once all documentation and patient information has been obtained, the referral can be completed, the patient is enrolled in the system and the order can begin progressing through the specialty pharmacy process.

Benefits investigation associates
Soon after receiving a new prescription, the benefits investigation commences. Benefits investigation team members must work with a sense of urgency regarding coverage of the medication.

Does the patient have insurance? Is the pharmacy in-network? Is the medication covered and, if so, is it under the prescription or medical benefit? Does the prescription require prior authorization (PA) or further documentation from the provider office? Does the patient have a copay or deductible and is the member eligible for manufacturer copay assistance?

Coverage determination can often become a rate-limiting step regarding the patient’s prescription being filled in a timely manner. Benefits investigation associates work tirelessly to obtain the appropriate benefit information by performing outreach to providers, insurers, and patients alike.

Once benefits are confirmed, the prescription can be properly processed or adjudicated and the patient’s out of pocket expenses can be assessed and the specialty pharmacy workflow can continue. Even after insurance has been established for a patient or if a patient requires a different medication at another point in time, benefits investigation expertise may be called on again.

For refill patients, benefits investigation associates play an integral role in ascertaining any changes to insurance coverage and the renewal of PAs.

Pharmacy technicians
In addition to performing typical duties, such as prescription entry and filling/labeling medications for dispensing, pharmacy technicians have expanded roles in specialty pharmacy. Depending on state laws, these additional duties may include outreach for prescription renewals, obtaining information regarding prescription clarification, and performing non-sterile and sterile compounding of various dermatological preparations, intravenous solutions, and infusions.

The role of pharmacy technicians can have direct and indirect implications on the specialty patient’s journey. In some instances, pharmacy technicians may have direct contact with patients and providers and assist with aspects of PA.

In other duties, the pharmacy technician’s role provides additional support to pharmacists, such as ensuring that all necessary supplies are entered along with the medication. Their attention to detail allows pharmacists to focus on clinical tasks and spend more one-on-one time with patients, once again shifting the focus to patient care.

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