Adding Real Value: How Specialty Pharmacies Deliver on Value-Based Care

For the past few years, there has been a lot of talk about the importance of collaboration between biopharma manufacturers, specialty pharmacies, payers, physicians, and the patients who we collectively serve when it comes to value-based care initiatives. However, it has been challenging for these conversations to come to life even when we all acknowledge that putting the patient at the center of everything we do and working together cannot only improve care, but drive toward better value.

For specialty pharmacies who are excelling at high-touch, white glove, patient care—now is the time to take these conversations forward and be the ones who bring together each of the spokes on the wheel, including biopharma partners, payers, providers, and patients—to create a differentiated, customized, and patient-centric approach to value-based care collaboration. Specialty pharmacies are best positioned to lead value-based care because they are already working with all of these stakeholders. They are already creating customized solutions to deliver the best care for patients and provide individualized therapies.  

High-touch specialty pharmacies recognize that we cannot have a “one-size-fits-all” approach to patient management. A patient’s care plan must be dependent on their disease, treatment regimen, and patient-specific characteristics—such as overall performance status. Often, biopharma manufacturers will selectively partner with experienced specialty pharmacies that have demonstrated their ability to customize services to ensure the best patient journey possible. Additionally, payers will also partner with specialty pharmacies to create payment models, which reward the pharmacy for achieving certain performance metrics or patient outcomes.

For example, oncology is a therapeutic category that demands partners who are committed to customized, enhanced services, given that there are over 60 different diseases, with many types that are very unique, requiring a variety of therapies. Cancer affects less than 1% of the population but accounts for 10% of all health care costs annually. It takes dedication to the field of oncology and significant therapeutic experience and expertise to know when and how to add value. In addition to customization, specialty pharmacies that support the management of patients on oral oncology therapies must have robust core services in the areas of patient access and clinical management. Patient-access services ensure that patients can quickly get their prescription through the insurance process and receive a comprehensive evaluation of financial-assistance options to help offset their copay. Then clinical management teams provide ongoing support from pharmacists, nurses, and technicians to ensure that patients adhere to their medications and create the best possible outcomes. 

Biologics, Inc, a McKesson specialty pharmacy is focused on providing tailored services for patients in the oncology, neurology, and complex-care markets. We work hand-in-hand with biopharma and providers to ensure that patients receive the care they need specific to the therapy they are receiving. One example where additional services make a difference in health outcomes is with an orally administered drug that treats patients following an overdose of a common oncology infusion with potentially life-threatening toxicity. Biologics has a customized clinical care plan for this emergency medication and the process happens much faster than normal, within hours not days (table). 

As the market looks to collaborate to execute on the vision of value-based care, it is clear that specialty pharmacies can have a significant role in both pulling the key stakeholders together, as well as in supporting them by providing high-touch clinical care. This ensures that patients receive their therapies quickly and stay on them long enough to have a successful outcome. Additionally, payers need a much broader data set beyond what they have access to today: 

•  Claims data to truly evaluate the effectiveness of a therapy and the patient’s quality of life.  

•  Robust clinical data collected by specialty pharmacies during numerous touch points and interventions, which help providers and payers understand the real effectiveness of any drug in their formularies. Often, knowing why a patient stopped using a drug is the most important information for future decision-making. 

In the near future, I’d also anticipate that specialty pharmacies will continue to innovate in their technology solutions, particularly patient-facing solutions to further understand patients’ attitudes and behaviors related to their therapies, adding another layer of insight into their journey. We are already seeing innovations such as smart bottle caps, smart phone apps, and telemedicine, all of which will help manage the patient and provide more information to the manufacturer and payer. High-touch specialty pharmacy care is being redefined rapidly in today’s market and these changes will surely help create more “value” in a value-based care model.