Increasingly, integrated delivery networks (IDNs) are creating their own full-blown specialty pharmacies. Many are familiar with the integrated payer-provider model from groups such as Kaiser Permanente. However, other IDNs are getting into the game according to a recent white paper.
Why are IDNs considering creating their own specialty pharmacies?
- Address patient access concerns. The number of limited-distribution drugs (or LDDs) is growing, and mandated specialty pharmacy carveouts create barriers to access for patients.
- Increase revenue. IDNs margins are often thin and bringing in high-cost specialty products may be a money loser if there are too many hand-offs in the distribution chain between manufacturer and patient. This results not only in lost revenue but also increased time to delivery as well.
- Address fragmented care. Since IDNs treat patients on the front line, pharmacists in specialty pharmacies can help alleviate patient burden of having to deal with a fragmented system and to go elsewhere for their pharmaceuticals.
- Improved data capabilities. Most pharmacies do not have access to medical records; most provider EHRs contain data on prescriptions but not fills. Combined medical records EHRs with pharmacy fill data can provide enhanced data to manage population health.
- Allow for real-world outcomes research. Value-based or outcomes-based contracting depends not only on data from pharmacy use but also having access to high quality patient outcomes. Specifically, “IDN-owned specialty pharmacies claim to deliver outcomes data that much more closely matches manufacturer expectations, compared with products administered in a more traditional, fragmented manner.”
- Better coordinate across sites of care. Specialty drugs don’t just come in a pill. They can be administered as home infusion and delivery services, infusion facilities, institutional pharmacies (e.g., acute care and rehabilitation), walk-in pharmacies, as well as separate hospital wings or clinics focused particular therapeutic categories (e.g., fertility, oncology, organ transplantation)
- Address social determinants of health. IDN specialty pharmacies may know more about patients social determinants of health and may be able to leverage IDN population health resources to help overcome any medication barriers.
Consider the following examples of IDN specialty pharmacy implementation:
Berkshire Health Systems in fall of 2018 expanded its specialty pharmacy program into diabetes care and now plans to extend the model to other chronic diseases. Dignity Health is looking to use specialty patient management strategies and population health techniques for COPD and other conditions.
IDN-based specialty pharmacies may not replace current specialty pharmacy industry leaders, but they may play an increased niche as integrated care becomes a priority.