Is Your Specialty Pharmacy A Dispenser, An Advocate, Or An Innovator?

Specialty drugs are expected to represent 40% of total Rx spend by 2020 so guess what…they’re the focus. Generic Rxs represent 80% of the oral drugs dispensed today and are low cost. PBMs, pharmacies, and payors are and should be focusing on specialty drugs.

Of course, this is driving a shift towards price compression and medical management types of functions like PA, UM, ST, case management, and even disease management.

So…what should your specialty pharmacy be focused on?

  1. Integrating medical and pharmacy benefits and data (a lot easier said than done as many have tried and failed).
  2. Using technology to engage physicians including social media, iPad apps, and EMRs.
  3. Providing a holistic solution that enables patients to self-manage, understand their disease, and improve their adherence to minimize waste and improve outcomes.
  4. Work with providers to be part of the broader care team and subsequently the shift to P4P (pay-for-performance) from FFS (fee for service).

I think this is going to require a tighter coupling of population health companies with specialty pharmacies and potentially better leveraging pharma manufacturers as partners versus suppliers.

This is not just a cost challenge…this is about outcomes. I usually think of it in terms of “The Triple Aim” which is about cost, quality, and experience.

If you look at your specialty pharmacy partner, I think you could put them in 3 buckets:

  • Dispenser – Focused on operational metrics (TAT, ASA) and lowest cost dispensing.
  • Advocate – Focused on “hub” type services that address basic patient needs (mostly patient out-of-pocket costs) and look at pharmacy focused case management.
  • Innovator – Focused on using technology and data (medical, pharmacy, lab) to create differentiated outcomes through patient engagement, participating in the care team, and personalizing medicine.
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