Thrifty White Pharmacy 9/5/2014. Specialty Pharmacy. Specialty Pharmacy: The Opportunities and the Challenges

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1 Specialty Pharmacy: The Opportunities and the Challenges MPhA Annual Conference September 12, 2014 Justin Heiser, PharmD Senior Vice President, Pharmacy Operations Specialty Pharmacy High cost and/or high risk medications What Makes Specialty Products Different? Complex regimens used for complex conditions - may require special storage, handling, distribution and/or administration requirements Reimbursement: may be eligible for multiple forms of benefits processing, as well as additional external programs to help reduce costs. Therapy Management Services: ongoing patient education and counseling to assess adherence, manage patient dosing and monitor drug effectiveness and safety. Specialty Pharmacies: Are They Different? Additional Services to Help Patients, Payers and Manufacturers. Regular reassessment of therapy, dosage, patient reported issues and appropriateness of therapy Disease- and medication-specific patient care management services tailored to meet the individual needs of each patient. Managing refill schedule preventing interruption of therapy while minimizing avoidable waste Pharmacy and medical benefit billing as well as addressing prior authorization requirements Data reporting, risk evaluation and mitigation strategies (REMS) Coordination of required home-care services Access to clinical staff 24 x 7 x 365 in order to support routine and emergent patient issues 1

2 Specialty Drug Dispensing Manufacturers or payers can prevent you from being able to order or dispense a med if your pharmacy isn't in the "network" Some drugs that we were once allowed to be dispensed at traare now being "locked out" and we can t order any longer However a number of new specialty meds continue to come to the market with "open" distribution so that a traditional pharmacy can order and dispense Overcoming Dispensing Challenges Your ability to dispense will depend on the drug and your pharmacy About half of patients don t take their chronic meds as directed and approximately 30% of new prescriptions are never picked up by patients. Adherence is a huge concern with specialty meds and providing solutions involves identifying the barriers and potential solutions: Foundation assistance and patient assistance programs Compliance packaging Specialty at retail options Patient education Medication therapy management Incorporation of technology Customized patient outreach and support services Improve Adherence Source: Viswanathan M, Golin CE, Jones CD, et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med 2012;157: Patient outreach Customized Support Services Welcome to Therapy Calls Side Effects Assessments Refill Reminders Late to Refill Calls Custom outreach at key points in therapy helps increase patient compliance 2

3 Compliance Packaging HealthyPack Rx TM Organizes all of a patient s prescriptions into pre-sorted packets Each packet is clearly marked with the date and time to be taken (i.e., Breakfast, Morning, Lunch, Dinner or Bedtime), as well as the name and physical description of the contents. Rx Timer Cap Replaces a regular vial cap and features a built-in LCD timer that automatically counts the minutes and hours since a patient last took their medication. Medication Therapy Management Patient training and education is essential to the specialty pharmacy service model. A well-informed patient (or care giver) is better prepared to be a partner in his/her own care plan. Knowledge helps patients deal with difficult side-effects, improves communication on therapy effectiveness, and solicits engagement in therapy management decisions that may be required. Clinical pharmacists: Proactively manage therapy throughout course of treatment Minimize adverse events, ensure patient safety Play an integral role in achieving optimal clinical economic Patient Education Tools, education, and resources to self-administer these meds; assuring they know how to use any medication delivery devices Face to face consultation; phone consultation; written documentation Video overview of various disease states (autoimmune, multiple sclerosis, oncology, hepatitis C, etc.) How to use self-administration devices (inhalers, peak flow meters, nasal sprays, pens and injections) Proper disposal of meds or sharps 3

4 Medication Synchronization Additional tools Additional tools a specialty pharmacy may deploy to increase patient adherence: Administration Prompts Refill Reminders Pickup Reminders Discharge Counseling MTM Specialty at Retail For added convenience, specialty pharmacy patients often opt to pick their specialty medications at a local pharmacy location. Benefits to patient include: A flexible and reliable alternative for patients who prefer to pick up their medications locally at no additional charge rather than receiving shipments to their home or office. Patients continue to work with their care team to receive high-quality care and personal services. Patients can connect via video/audio link in a private consultation room to their specialty care team Building Excellence and Quality Internal elearning Management System Education & competency assessments for staff are assigned via job code automatically Certified Pharmacy Technician Certification and Ongoing Training Motivational Interviewing Training Certified Specialty Pharmacist Training Immunization Certification MTM Delivery Certification High-level of ongoing education to facilitate best possible patient outcomes 4

5 Thrifty White Specialty Pharmacy Care Team Performs patient onboarding, reimbursement and compliance services utilizing highly-trained specialty care coordinators and leveraging quality technology partners. Patient onboarding and intake Reimbursement support Foundation assistance and patient aid programs Clinical support and specialty pharmacy services Compliance and persistency/adherence services Data management services Physician communication (outbound & inbound contact) Thank you Justin Heiser, PharmD Senior Vice President Pharmacy Operations