By Tammy Zukowski and Kristin Fox-Smith

Visante consultants recently attended the annual Asembia Specialty Pharmacy Summit (formerly Armada) in Las Vegas. We were encouraged to see many of our health system colleagues in attendance, including representatives from both large national specialty pharmacies, and smaller specialty pharmacies. Many in attendance were hoping to interact with payers and manufacturers in an attempt to help forecast where the specialty pharmacy market is headed and to be at the forefront as the market evolves.

Missing in the discussion: specialty pharmacy in hospitals

Many discussions at the summit centered around the rise in specialty pharmaceuticals, a continually evolving marketplace, and the impact on the numerous stakeholders, such as payers, manufacturers, wholesalers, and dispensing channels. Payers continue to articulate the ongoing struggle to extend access to specialty therapies, while also managing cost, under both the medical and pharmacy benefit. Manufacturers continue to address their strategy for ensuring patients have access to their drug while being effectively managed. Wholesalers face the ongoing challenge to drive down acquisition cost as the increase in new specialty drugs are channeled to the national specialty pharmacies.

Disappointingly, missing from the discussion at Asembia was how health system specialty pharmacies are driving down cost and improving patient outcomes. Health system pharmacies can and do play a vital role in specialty pharmacy, improving outcomes and managing costs. Our work with hospitals and specialty pharmacies of all sizes demonstrates the impact of a hospital’s tight transitions of care, clinical expertise, direct interaction with prescribers and patients, and robust internal retail and specialty pharmacy services, which ultimately result in better patient outcomes. Unfortunately, data to support this premise and demonstrate the opportunity that exists within health systems is lacking. Therefore, it is critical that hospitals begin working with payers to leverage the “at risk” model that provides increased support for creating a robust specialty pharmacy infrastructure within health systems. 

Value-based and at-risk contracting

As one might imagine, there was much discussion at Asembia centered around  and focused on value-based or at-risk contracting arrangements. Who better to define the framework of these arrangements than a health system with a specialty pharmacy and the ability to manage the entire continuum of care? It is critical for health systems to have these discussions around contracting arrangements with managed care contracting resources – before it is too late and our colleagues are locked out of networks and payer contracts. The commercial market, manufacturers and distributors alike continue to develop their investment in the specialty pharmacy space, and health systems should not be left out of this conversation. Failure to engage will result in the inability for health systems to provide specialty care for their own patients and will increase fragmentation of care and potentially lead to less than optimal outcomes.

If acted upon quickly, health systems have a golden opportunity to redefine the specialty pharmacy space. In a time where payers and our government alike are trying to aggressively manage cost without compromising outcomes, the time is now! While many specialty pharmacies in the marketplace focus on patient care and outcomes, at the end of the day, a health system bears the responsibility for the patient regardless of its ability to dispense a retail or specialty medication. This is the time for hospitals and health systems to impact and help shape this continually growing segment of the pharmacy market. Engaging in an ongoing dialogue with managed care contracting departments to participate in value-based contracting opportunities to leverage the health system’s internal expertise is critical. Furthermore, as data becomes an increasingly vital element to payer contracts and medication access, participating in strategies designed to aggregate data will continue to be essential to improve the ability to demonstrate better outcomes to payers and manufacturers. It is integral that pharmacy is included in any value based contract to ensure all players are aware of the value pharmacy provides far beyond the bottom line and margin.

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