Written by  Matthew H. Rim, Lonnie Smith (PharmD), and Michael Kelly (MBA, RPh)

Abstract Summary

Although the system’s pharmacy department had developed specialty pharmacy services for patients with certain conditions, it was necessary to expand and standardize those services to meet the needs of all specialty clinics because (1) many of the clinics had experienced an increased volume of prior-authorization requests due to the introduction of new specialty drugs, (2) the dispensing pharmacies were operating at maximum capacity due to the previous decentralization of specialty pharmacy operations, and (3) payers had sent notice that they would require accreditation of the specialty pharmacy program as a condition of participation in their specialty pharmacy networks. To ensure standardization of services and successful preparation for increasing numbers of specialty prescriptions, all specialty pharmacy services were centralized to the healthcare system’s Pharmacy Ambulatory Clinical Care Center (PAC3). PAC3 centralized the prior-authorization process to selected specialty clinics. A call center was developed at PAC3 to provide centralized specialty pharmacy services, including 24-7 patient support, a medication adherence program, home delivery service, and patient education. The program resulted in a 137% increase in specialty pharmacy revenues over a two-year period. PAC3 processed 1860 prior-authorization cases and enrolled approximately 700 new patients in the specialty pharmacy program within nine months.

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