HOSP to advocate for better access to more seamless care
By Megan Headley
Specialty pharmacies, which focus on delivering medications for more complex and chronic illnesses, are no longer the rarity they once were. In 2016, the American Society of Hospital Pharmacists reports, about 9% of health systems owned an integrated specialty pharmacy; by 2018 that had jumped to 20%, and today the number is closer to 25%. It’s a model that promises tremendous benefits for patients by making medication management more seamless.
Yet, with approximately 70% of specialty prescription revenue still being dispensed by the biggest four specialty pharmacy companies—CVS Specialty, AllianceRX, Optum, and Accredo—these health system-owned specialty pharmacies have limited leverage in securing affordable access to the medications their patients need.
That comparatively smaller “voice,” explains Louis Sokos, BS Pharm, MBA, WVU Medicine Allied Health Solutions Specialty Pharmacy director for the WVU Health System, is a significant part of the goal behind the newly formed nonprofit Health System Owned Specialty Pharmacy Alliance (HOSP). “We’re working to band together to show the value of what we’re doing for our patients at our health systems,” says Sokos, a board member of HOSP.
What they’re doing may have significant ramifications for patient safety. As Sokos explains, the biggest benefit to this specialty pharmacy model is that the communication between the pharmacy provider, the patient, and the physicians becomes much more seamless.
The level of integration varies among health systems. Some health systems have pharmacists embedded in the clinics, while others manage their patients centrally from their operations center. In both scenarios, the documentation of education and patient counseling is captured in the health system’s electronic health record, in which both providers and pharmacists work.
“When we manage our patients at our own health system in our own specialty pharmacy, it’s clear that the provider knows what’s happening with prior authorization, patient education, and actual start date and continued management of the therapy with their patient,” Sokos says. “That transparency and integration between pharmacist, provider, and patient [leads] to better outcomes for our patients.”
Given that medication management has tremendous impact on patient care—perhaps more impact than the specific treatment itself, the World Health Organization says—this insight and in-room education can help improve the management of complex illnesses.
However, integrated specialty pharmacies face a range of challenges. These largely center around securing access to specific medications from the medication manufacturer or in securing a cost-effective reimbursement from the insurance company. That latter issue, Sokos says, can be particularly ornery since the prescription benefit management companies that own the competing specialty pharmacies would prefer to direct patients to their owned entities.
Data collection and reporting is another challenge Sokos hopes HOSP can help address. “There’s a lot of data that needs to be collected and recorded with regard to rare disease states and how patients are managing these disease states,” he says.
Of the approximately 7,000 known rare diseases, less than 10% have an FDA-approved treatment available. According to the FDA, rare disease drug development is challenged by a limited understanding of the variability and progression of each disease. To improve treatment options for many complex disease states, establishing common practices for data collection and reporting is a foundational need.
In addition, Sokos says, the combined advocacy of a group like HOSP could help more health systems work together to advocate for the 340B Drug Pricing Program. This federal drug discount program was developed to extend resources to an underserved patient population and increase the affordability and accessibility of pharmaceutical care.
“We’re in West Virginia. It’s a small rural state, and 40% of the patient population that we manage is Medicaid,” Sokos says. “The savings from the 340B drug discount program allow us to cover some of those losses we incur in managing a less fortunate patient population, and still keep our doors open.”
HOSP aims to leverage members’ experience to share best practices for navigating these challenges and delivering the best patient care and patient outcomes. Having been in the integrated specialty pharmacy space since about 2014, WVU Health System has developed its share of best practices.
Now, Sokos says, it’s time that health system–owned specialty pharmacies had a bigger voice in engaging manufacturers and insurance providers. “We want our collective voice represented in that discussion,” Sokos says. As he points out, “I don’t see the health system specialty pharmacies competing against each other. … We’re just trying to serve the patients that come through our doors at our health system. I think most of us are of the same mindset, so we’re willing to help each other.”
HOSP general membership is open to any qualified health system that seeks to embrace the organization’s mission of delivering critical care excellence through health system–owned specialty pharmacies. To learn more about HOSP, visit http://hospalliance.org/membership.
Megan Headley is a freelance writer and owner of ClearStory Publications. She has covered healthcare safety and operations for numerous publications. Headley can be reached at firstname.lastname@example.org.