Teva intros generic Axert
Specialty Rx partnership with Diplomat helps McKesson’s independents level the playing field
SAN DIEGO — Phil Hagerman, CEO and Chairman of Diplomat Pharmacy, Inc., joined attendees as a special guest speaker for a “Specialty Lunch and Learn,” at McKesson’s ideaShare 2015. “Specialty is the new pharmacy,” Hagerman said.
Currently, the specialty pharmacy market stands at $100 billion and is growing at a 20% trajectory. More than half of all new drugs approved in 2014 were specialty medicines, and eight of the top 10 best-selling drugs are expected to be in the specialty channel by 2016. By 2017, spending on specialty medicines is anticipated to represent 50% of the overall drug spend.
McKesson understands that specialty patients have unique needs and it can be very expensive and time consuming for a pharmacy to build capabilities to manage these patients. McKesson’s partnership with Diplomat brings the supportive specialty pharmacy services to local independent pharmacies without the upfront investment. The independent pharmacy continues to adjudicate the specialty claim and get reimbursed; Diplomat provides the wrap around access, reimbursement and clinical services, to enable a consistent and efficient level of care to all key stakeholders including the pharmacy, prescriber and patient.
As a pharmacist, Hagerman knows that managing all of these services in house can be challenging. “Historically, the prior authorization and funding support process is the hardest thing for a retailer,” Hagerman said. As many as 4-out-of-5 specialty drugs require a prior authorization. “Our overall 2014 success rate on prior authorization on first pass is 86%,” Hagerman said. “And our overall 2014 prior authorization on appeals is 83%. We want to help our retail partners with this process.”
In addition to providing the specialty services, retail pharmacies have also been faced with an increase in the number of limited distribution drugs. “Limited distribution is a challenge, but I would say it’s one of the biggest opportunities for independent pharmacies, because if you have a specialty physician in your community, the most important thing you can do is get him to trust that whatever patient prescriptions he sends to you, you will take care of,” Hagerman said. “That doesn’t mean you will always be able to fill the prescription, but it does mean that you’ll take care of the patient.” Failing to meet a specialty patient’s needs is the kiss of death for a pharmacy. Delivering on those needs; however, brings a high-cost patient through your door — a patient who also is quite likely to also be on a high number of maintenance prescriptions.
The McKesson Diplomat relationship enables a participating store to send any limited distribution drugs to Diplomat in a non-predatory relationship. The patient is staying with their local store, just the one specialty script that can’t be filled locally will be sent from Diplomat to the patient. “We want to keep the retail store whole and keep their patients happy,” Hagerman said.
Once the store chooses to participate in the program, it is important to make it known to both area doctors and pharmaceutical reps that specialty prescriptions can be filled at your store. This is a critical patient acquisition tool, Hagerman added. “Even if the pharmaceutical rep is not your friend today and he’s sending everything to another pharmacy, when the doctor calls him with a problem, that rep has to have a solution,” Hagerman said. “You are that solution. Do not discount how important that is.”
Sunrise session helps McKesson ideaShare attendees navigate pay-for-performance models
SAN DIEGO — Attendees at McKesson ideaShare 2015 met the sunrise Friday morning with a special breakfast session that aimed to help independent pharmacies navigate the changing reimbursement landscape and gain entry to more narrowly focused preferred pharmacy networks.
In the session “Value-based Reimbursement Models and Their Evolving Role in Network Access,” co-presenters Kevin Connor, AccessHealth VP/GM; Eyad Farah, AccessHealth VP business development and strategy; and Stacey Decembrele, Express Scripts director of innovation and strategy retail channel management, spoke about how pharmacies can adapt to the new model.
Connor talked about one of the main trends taking place in community pharmacy today: the shift to value based reimbursement and the development of pay for performance models. In these models, patient outcomes dictate how a pharmacy is compensated; whether it’s performance-based reimbursement or per-patient incentive payments, where health plans pay pharmacies for conducting specific interventions and providing clinical services that leads to better health outcomes. As these innovative payment models continue to grow, what we’re going to see in the market place is some combination of all of these. In addition, this trend coincides with another important change impacting community pharmacy today, and that is the continued growth of narrow networks. Connor stressed that clinical performance will continue to have a growing impact on gaining access to preferred networks as well as improving pharmacy economics via value based reimbursement models.
Acknowledging the ways that changing reimbursement models and an emphasis on quality can change the way pharmacies operate, Decembrele provided several examples of how Express Scripts is working to help pharmacies collaborate better with health plans.
One initiative Express Scripts has undertaken is plan-specific quality reporting that ensures plans have access to Star quality-measurement information about pharmacists that they need to make future decisions about which pharmacies are providing their patients with the best care.
According to Decembrele, Express Scripts also is partnering with plans on plan-specific pay-for-performance initiatives to reward top-performing pharmacies, as well as those that had demonstrated improvement in driving health outcomes.
“We are certain from the data and conversations that certain pharmacies are doing more to make an impact on patient care,” Decembrele said. “Certain pharmacies are going above and beyond their standard operating procedure to support SCAN patients and support SCAN Star ratings. They're using the actionable data daily, and they use it immediately when it becomes available from us.”
Decembrele added that the movement toward pay-for-performance initiatives is an opportunity for retail pharmacy. Farah also emphasized this while outlining the ways AccessHealth can help make the transition manageable for community pharmacists, including leveraging awareness campaigns like the Health Mart-hosted town hall meetings with independent pharmacists that are taking place throughout the country and making investments in tools and services to increase customer and patient engagement like PQS EQuIPP access and Medication Synchronization solutions like StarWellness from PrescribeWellness, and utilizing a team of AccessHealth Advisors who provide reoccurring guidance around performance scores.
“We saw this shift coming, and we wanted to set up our pharmacies for success,” Farah said.
In terms of easing the transition so that pharmacists are able to provide the services needed to boost their performance and their reimbursements as a result, Farah pointed to the value of implementing a Medication Synchronization program.
“You can’t change your business model tomorrow, but if you start putting the foundation in place where you have more efficiencies to be able to dispense more scripts, but also free up time to provide those additional services to patients, that’s a win-win. Pharmacists are being asked to do more for less, which is challenging for the current business model, but there are also opportunities to drive patient outcomes and improve reimbursement at the same time,” Farah said.