The incremental approach to establishing a specialty pharmacy
In our research into health system-owned specialty pharmacy, we've found that many health system leaders are overthinking their specialty pharmacy strategy. Often, leaders assume their first step is to hire a consultant to help them build a full-service, accredited specialty pharmacy capable of dispensing across all disease states to all patients. However, in addition to requiring substantial upfront costs, this approach typically means that organizations must wait one-to-two years before their specialty pharmacy serves its first patient.
In contrast, according to our research, many leading organizations took an incremental approach to building their specialty pharmacy capabilities. Instead of seeking to serve all patients right away, these organizations started with a defined patient population, serving those patients from their existing retail pharmacy infrastructure before expanding to other patient populations. Two common starting points include oncology and transplant—oncology because of the large number of open-access drugs, and transplant because of the greater need for ongoing care coordination. This incremental approach requires less upfront investment, and it helps build a stronger case for larger-scale build-out in the future.
Two prerequisites for establishing an effective specialty pharmacy are: 1) a strategy for managing and tracking patient care, and 2) a specialized pharmacy staff. Here's how others are meeting these needs in a way that sets them up for incremental growth.
1. Homegrown care management tools a cost-effective starting place
From day one, specialty pharmacies must have a strategy for managing patient data and communications. While most organizations with more established specialty pharmacy capabilities use a commercial specialty pharmacy software platform, these tools are pricy. Organizations starting small with specialty pharmacy often find it difficult to justify the investment.
As an alternative, many have found success using spreadsheets to track necessary metrics. For instance, at one NCI-designated cancer center, the specialty pharmacy uses a detailed spreadsheet to track each patient's medication regimen and follow-up communications. The majority of data—such as patient name, call back dates, and drug shipment dates—are manually entered. Formulas within the spreadsheet then auto-populate additional data to meet payer reporting requirements. The specialty pharmacy is currently only "in network" for one payer, so as the institution pursues accreditation and inclusion in additional payer networks, they will need to consider using more robust patient management tools.
2. Dedicated pharmacy staff supports collaboration for patient outcomes, organic growth
Even the smallest specialty pharmacies need specialized staff to communicate with patients and providers, complete prior authorizations and financial assistance, and dispense medications. For organizations using an incremental approach to growth, staffing can often be as simple as starting with one pharmacist and one pharmacy technician dedicated to a particular disease state.
Having clinical pharmacists dedicated to—or even embedded in—specialty clinics enables them to develop relationships with providers and clinic staff, thereby ensuring collaboration on patients' care regimens. The integrated model supports effective coordination around patient care and keeps the health system's specialty pharmacy top-of-mind for providers, increasing referrals to the in-house specialty pharmacy.
Some health systems deploy technicians in clinics, rather than pharmacists, tasking them with prior authorization and financial assistance tasks. Patient volumes and provider and clinic needs should influence whether a specialty pharmacy deploys pharmacists or pharmacy technicians in the clinic setting.
Once a health system specialty pharmacy develops meaningful relationships with provider clinics through its pharmacist and technician in one specialty clinic, the result is most often program expansion through word-of-mouth recommendations to scale the same process to other clinics.