Over the last few years, “doing more with less” has become a mantra for most hospitals and health systems. Many are now looking at specialty pharmacy services as a way to strengthen their financial portfolios, reduce administrative burden and deliver more patient-centered care.
Becker’s Hospital Review recently spoke with Allison Arant, senior vice president of client development and marketing at Clearway Health, about how specialty pharmacy services can support care coordination and management, community and public health and stronger contribution margins.
Specialty pharmacy services can improve the financial health of hospitals & health systems
Most healthcare leaders today are simultaneously striving to increase revenue and reduce costs. Only recently, however, have hospitals and health systems started to look at specialty pharmacy as a tool for achieving these goals.
That’s because the 340B Drug Pricing Program was designed to provide access to drugs at a discounted rate for eligible covered entities, providing revenue for health systems to stretch funding for much needed programs, Arant explained. “It is recognized as a way to drive revenue back into organizations, while providing care and increasing access for underserved patient populations,” she said.
Specialty pharmacy programs have been shown to substantially reduce the total cost of care by 60% annually, which translates into meaningful margin improvements. Well-executed specialty pharmacy programs, in conjunction with the 340B Drug Pricing Program, have shown substantial decrease in cost of drugs for the system and equally substantial improvement in patient adherence and outcomes. “Specialty pharmacy generates revenue in the right way to create positive, healthy operating margins for health systems,” Arant said. “Millions of dollars of annual revenue are available through specialty pharmacy if healthcare organizations navigate it in the right way.”
Clearway Health partners with hospitals and health systems to build or strengthen their specialty pharmacy programs. Doing so can improve access to care, offer personalized support to vulnerable patients and families and eliminate crucial administrative tasks for providers and care managers.
Clearway Health was born out of Boston Medical Center Health System (BMCHS) as a program to help keep the hospital’s doors open and support the complex medication needs of patient populations. Eventually, Clearway Health evolved into a separate, standalone business entity. Today, specialty pharmacy services make up more than 25% of the total financial contribution for BMCHS. “That’s the transformative power that these programs have,” Arant said.
Helping healthcare organizations take the first step in offering specialty pharmacy services
Arant said it’s a myth that only large, integrated delivery networks and major hospitals and health systems can have their own pharmacy and specialty pharmacy departments. Clearway Health has found that community hospitals and even solo, independent hospitals can effectively provide specialty pharmacy services.
“One major barrier is understanding the data and the opportunity that exists,” Arant said. “As Clearway Health explores partnerships with clients, we conduct a complete assessment of the prescriptions that are written and where they are being filled. When we review the data, we often find that health systems are capturing only a miniscule part of the total available specialty pharmacy opportunity.”
Another common hurdle is concerns about changes in the 340B landscape. Some pharmaceutical manufacturers have critiqued the program and how it’s been used. As a result, many hospitals and health systems are wary.
“Some drug manufacturers have said that hospitals and health systems must choose one contract pharmacy within a 40-mile radius, and they can only use that specific pharmacy to fill prescriptions,” Arant said. “That’s daunting for a community hospital, large academic medical center or major IDN. However, working within the 340B regulations in a compliant way is completely within the reach of healthcare organizations.”
Clearway Health eliminates these obstacles and provides hospitals and health systems with the necessary data to provide specialty pharmacy services, rather than allowing competing pharmacies to absorb that revenue. The company understands the complex specialty pharmacy landscape, the complicated and often changing government regulations and how to work with payers, pharmacy benefit managers and drug manufacturers.
“From a patient perspective, medication adherence is typically defined as whether the patient takes their drugs in the way in which they were prescribed,” Arant said. “We talk about access to medication first, because without access, there is no adherence. Yet, hospitals and health systems often struggle to access specialty drugs for their own organizations. Many are so rightfully focused on patient access, they miss opportunities to leverage a service like specialty pharmacy that could be one of their highest revenue producers and drivers of patient loyalty.”
Clearway Health reduces clinician burden + improves patient access to specialty drugs
Specialty medications commonly require prior authorization from payers. From an administrative standpoint, approval cycles can be intensive and take hours, days or even weeks.
“The industry average for prior authorization for specialty medication therapies is up to 17 days,” Arant said. “It’s no surprise that clinical care teams spend valuable time chasing insurance companies for approval. At the same time, patients must go weeks without lifesaving or life-changing medications.” In fact, in a survey of 1,000 patients, 55% of patients reported a delay in receiving their specialty medications because of prior authorization turnaround time.
Clearway Health embeds dedicated pharmacists, clinical pharmacists and specialty pharmacy patient liaisons into their clients’ specialty clinics and pharmacies. They work alongside providers and care team members to ensure better care coordination. Onsite, Clearway Health team members are supported by experts who lead access and advocacy efforts on behalf of organizations and their patients.
“Clearway Health promotes provider and clinician well-being by removing administrative burden,” Arant said. “We typically secure prior authorizations in a day and a half or even less.”
As a result, providers can see more patients. On average, providers spend nearly 15 hours per week on their prior authorization workload. 71% of nurses report that they are less than satisfied with the amount of time they spend on the phone with insurance companies battling for prior authorizations and approvals.
Arant described how, prior to adopting Clearway Health, one provider partner devoted four days per week to clinic visits and set aside her complete fifth day to contact insurance companies for prior authorizations — as well as to conduct follow-up calls to patients for education.
“Thanks to our service, that clinician is now able to see patients five days a week,” Arant said. “All of the administrative tasks that she was doing related to specialty medications are now handled by the experts that Clearway Health has embedded in the clinic.”
Clearway Health’s pharmacists and specialty pharmacy liaisons serve as patient counselors and advocates, navigating care pathways, including insurance pre-authorizations, coupons and manufacturer discounts. They also review medical therapies and provide ongoing patient education, which improves access and supports patients on their specialty pharmacy journey.
“This is important in a world where nearly one third of initial prescriptions go unfulfilled due to reasons like cost, prior authorization denials, clerical errors, missing medical documentation and more,” Arant said. “All of these factors create barriers to adherence for patients and unnecessarily consume time for providers. Specialty medications, in particular, can be extremely expensive with very high copays. This environment requires care coordination in the ambulatory specialty care setting.”
Specialty pharmacy services promote public and community health
Clearway Health’s specialty pharmacy services are playing a central role in many community health projects that are focused on diminishing health disparities, preventing disease and providing equal access to care for all. One example is the screening program for hepatitis C that Clearway Health built at Boston Medical Center.
Hepatitis C is one of the deadliest infectious diseases nationwide, according to the CDC. The preventive screening and treatment programs created by Clearway Health include improved testing protocols, clinical workflows, patient education and treatment plans.
In the last eight years, Arant noted, Boston Medical Center has treated more than 3,000 patients for hepatitis C. “Many of these patients had disparate social determinants of health, psychosocial factors, chronic homelessness or high alcohol and illicit drug use,” she said. “Of those 3,000 patients, 90% have completed treatment and 96% of those patients treated have been cured.”
A pathway to improved access + outcomes for organizations at any stage
Clearway Health partners with hospitals and health systems that are at different stages of their specialty pharmacy journeys to deliver patient-centered, connected and coordinated care. Some have well-established specialty pharmacy programs, while others don’t have a pharmacy at all. The important thing for all organizations to remember is that it’s not too late to get started.
“It can feel so daunting at times — healthcare leaders may think it’s too late to explore specialty pharmacy services,” Arant said. “But it is important to realize that it isn’t too late. The key is to find the right support system, whether that’s sharing information with colleagues at another health system or partnering with a specialty pharmacy expert like Clearway Health. A specialty pharmacy services program can accelerate gains for healthcare organizations, as well as the communities of patients that they serve.”