How health systems can ensure their specialty pharmacy delivers measurable value

The landscape for specialty pharmacy has evolved tremendously, as the number of breakthrough medications approved each year continues to grow. These specialty drugs bring hope for many patients but add cost and complexity for payers and providers. In this increasingly complex environment, health system specialty pharmacies must find ways to measurably demonstrate outcomes and value.

In a Becker's Hospital Review podcast, sponsored by CPS, Brandon Newman, PharmD, MMHC, CSP, chief operating officer, and Jessica Mourani, PharmD, director of clinical outcomes — both of CPS — discussed the growth and benefits of health system specialty pharmacy services and the importance of clinical outcomes measurement.

Five key takeaways were:

1. Specialty pharmacy continues to rapidly evolve. The benefits are enormous, as are the costs. Specialty pharmacies are service lines within hospitals and health systems charged with dispensing and managing specialty medications. These are the specialized, high-cost and often complex drugs for specific patient populations.
   
   Specialty pharmacy has exploded as the number of approved specialty medications increases each year. These medications are great news for patients, many of whom have chronic diseases. Some of these drugs offer a cure, while others drastically improve patients' quality of life.
   
   "However, the costs of these drugs can be staggering," Dr. Newman said. "Specialty pharmacy therapies account for more than half of total drug spend, it's something we have to watch closely. . . There's a critical need for oversight to ensure that patients are well managed when they're on these expensive and complex medications. That includes ensuring access to the medication, managing the tolerability and side effects of the drugs and showing proof of good outcomes to stakeholders."
   
   

2. For health systems, specialty pharmacy is increasingly a business driver. "We've seen a steady increase in health system specialty pharmacies that hospitals are using as business drivers," Dr. Newman said. He continued by stating that hospital C-suite leaders are looking to their specialty pharmacies to support system-wide initiatives and to help position the organization for value-based care.
   
   
3. Health system specialty pharmacies can significantly enhance the patient experience and outcomes across complex patient populations. According to Dr. Mourani, health systems are growing their specialty pharmacies because of the many clinical benefits they offer. Health system specialty pharmacists work closely with care teams to monitor patients' therapy journey, assessing data like discontinuation rates, lab values, patient-reported outcomes measures and more. Closer monitoring means interventions and therapy adjustments can be made faster, which can have a big impact on the health system's goals. "We're seeing outcomes like reduced readmissions, better access to specialty drugs, improved payer relationships and overall decreased costs of care," she said.
   
   Dr. Mourani and the CPS team conducted evidence-based research with its partners to evaluate health system specialty pharmacy impact on patient outcomes. The team published this year's notable insights in CPS's second annual Patient Impact Report. This report provides research, benchmarks and best practices in measuring health system specialty pharmacy outcomes. Notable advancements in clinical outcomes measurement include patients living with:
   
   

• • Cancer. Adherence was 92 percent among partner health systems compared to a benchmark of 70 percent. Also, when pharmacists completed 14-day follow-up check-ins with cancer patients, overall medication discontinuation rates were reduced by 11 percent, and discontinuation due to drug intolerance, patient choice or limited patient communication significantly decreased.
    
    
  • Autoimmune conditions. These patients comprise the majority of spend for specialty conditions. Non-adherence can be costly, and many times therapy needs to be adjusted to remain effective over time. Among partner health systems, CPS uses patient-reported outcomes measure assessments to proactively track symptoms and quality of life. This enables more proactive interventions, including dosage and therapy changes when appropriate, to improve disease control. In 2022, specialty pharmacy teams collected Routine Assessment of Patient Index Data 3 (RAPID3) for 100% of patients, and over 50% of patients experienced a decrease in RAPID3 severity category as a result of their services.
    
    
  • Diabetes. Among partner health systems, adherence was 92 percent compared to a benchmark of 79 percent. Also, the A1c levels among high-risk patients declined by 20 percent and among lower-risk patients declined by 4 percent. Among the benchmark group, A1c only declined by 0.5 percent.
    
    

4. While the benefits of specialty pharmacy are significant, clinical and technological infrastructure is critical to standardize care and quantify value. Mourani noted that health systems still lack consistent and standardized processes around measuring clinical outcomes. Standardized processes and measures are needed to effectively track progress and performance of specialty pharmacy. "I predict that we'll see a lot of progress and a lot of maturity [in specialty pharmacy outcomes measurements] this year," she said. "The clinical benefits are definitely there but leaders must be able to consistently measure and improve them in order to demonstrate value."
   
   
5. Partnering with experts can help hospitals accelerate growth and value. To operationalize specialty pharmacy and maximize its value, Dr. Newman recommended that hospitals and health systems: 1) invest in people who are specialty pharmacy experts; 2) reevaluate the specialty pharmacy's clinical infrastructure and technology needs and 3) explore how a partner can help address these needs to accelerate growth. "Partnerships are key. Hospitals and health system executives don't have to forge this alone."
   
   CPS recently partnered with a hospital that already had an established specialty pharmacy. Within 30 days of initiating this partnership, CPS helped this health system grow its specialty pharmacy program by 35 percent.
   
   Specialty pharmacies will continue to play an increasingly important role in healthcare due to the growth in the number of specialty drugs and their cost. Challenges for health systems' specialty pharmacies include operationalizing their specialty pharmacy, gaining access to specialty drugs, effectively managing those patients who receive specialty drugs and demonstrating clinical outcomes and value in a consistent, measurable way.
   
   Partnering with organizations with deep expertise in specialty pharmacy and measuring clinical outcomes can help health systems implement specialty pharmacy, measure the clinical outcomes and demonstrate value.