The challenge

Payers, including health plans and pharmacy benefit managers, are increasinglyrestricting who can dispense or administer high-cost specialty medications forpatients covered by their plans. Health system leaders are concerned that thesepolicies threaten both patient safety and the financial sustainability of hospital-based pharmacy and infusion services. However, key stakeholders lack theknowledge and coordination necessary for health systems to address the impactof these restrictive payer polices.

The organization

University of Kentucky HealthCare (UK HealthCare) is an academic researchinstitution based in Lexington, Kentucky. UK HealthCare’s pharmacy servicesoperate seven retail pharmacies, including a fully accredited specialty pharmacyand a mail-order pharmacy. The pharmacy team works closely with UKHealthCare’s non-oncology infusion services.

The approach

UK HealthCare’s pharmacy leader took a collaborative approach to addressingthe impact of payer restrictions. He strengthened pharmacy’s relationships withinternal stakeholders to protect the health system’s specialty pharmacy andinfusion services. He also engaged external stakeholders to position the healthsystem’s pharmacy enterprise for lasting success.

The result

Strong internal relationships enable UK HealthCare pharmacy leaders to securethe support and resources necessary to protect health system pharmacyservices. These relationships position UK HealthCare to address ongoing payerrestrictions on specialty pharmacy and infusion services.