Specialty Pharmacies Helping to Evaluate Data and Use Technology to Reduce Costs and Improve Quality

Tampa—Within the next 5 years, specialty pharmaceuticals are expected to account for more than half of the overall drug spending in the United States. By 2016, 8 of the top 10 branded drugs will be specialty medications, while 53 specialty products are currently in phase 3 development, according to Rebecca Shanahan, chief executive officer, Avella Specialty Pharmacy.

Ms. Shanahan, who spoke during a general session at the AMCP specialty conference, said the healthcare industry must pay attention to the rising costs associated with specialty drugs. She said specialty pharmaceuticals’ stakeholders, such as payers, providers, patients, and pharmaceutical manufacturers, are interested in integrated care between the pharmacy and medical benefit, patient access and empowerment, documented quality through best practices clinical and formulary management and comparative outcomes, and predictable costs with a focus on value-based healthcare.

Collaborative Efforts

By working together, she said the different parties can use technological advances and analyze data to improve outcomes, increase adherence, and lower costs. “I think specialty pharmacy is one of the most important connectors in the healthcare channel today,” Ms. Shanahan said. “We find ourselves intermediating between patients and physicians, physicians and plans, plans and patients, plans and pharmaceutical manufacturers, and we find ourselves looking for more tools and more ways to use those tools to connect providers to deliver outcomes.”

Some specialty drugs, such as those for HIV, rheumatology, and multiple sclerosis, are delivered in retail pharmacies. In those cases, patients only receive phone calls to remind them of their refills and to discuss side effects. Other patients, however, take more complex drugs for oncology and other diseases and require more interventions and care through specialty pharmacies.

Generating Data

Specialty pharmacies and others in the healthcare industry are gathering more data than ever, according to Ms. Shanahan. Last year, there was 500 petabytes of healthcare data, which she said could increase to >25,000 petabytes by 2020.

Doctors are also embracing technology more than they did in the past. Ms. Shanahan cited a survey that found 66% of physicians used a tablet for medical services, and >50% said mobile devices helped them in decision-making and improving efficiency. However, she said 50% of medical oncologists in Michigan still use paper medical records, while 75% of referring physicians in Avella specialty pharmacies prefer faxes as their communication method.

“We have lots of data, but how we move that to actionable information ‘just-in-time’ is something that we all can share a concern about,” Ms. Shanahan said.

Program Examples

Several companies are developing programs to collect and analyze data. Ms. Shanahan mentioned the PathWare^™, a decision support tool for clinical pathways from Cardinal Health Specialty Solutions. The program is intended to provide the right drug to the right patients at the right time and is developed through physician advisory panels in collaboration with health plans. Cardinal Health works with networks of physicians and developed pathways that are network- and region-specific.

AIM Specialty Health, a specialty benefits management company, has a similar automated pathways and approval process for radiology, cardiology, and oncology. Providers participating in the program use AIM’s portal to prescribe and initiate treatments. They are rewarded for making decisions based on clinical criteria agreed upon by a network of physicians who examined clinical trials and other evidence-based methods before developing the pathways. Providers participating in the pathways program are eligible for enhanced reimbursement as well.

“These are great ways of marrying technology and the clinical process that allows people to have shared results but does not require a decision that is based on a list,” Ms. Shanahan said. “It allows for variation based on patients, physicians, and the local providers that are available.”

Frameworks SRx is another technological platform that helps connect patients, providers, and payers and allows them to share data on prescriptions and claims and track outcomes. In addition, provider portals are becoming more popular and allow physicians to track their orders in a more accurate and timely manner.

Patients are also benefiting from mobile applications to order medications and communicate with pharmacists. They are aided by text messaging programs that provide them with reminders to take their medications or undergo laboratory work and educational tips, such as blood pressure monitoring, motivational messages, and surveys.

Meanwhile, Navigating Cancer is a portal that allows patients to share their experiences following their cancer diagnoses and obtain information on their type of cancer, medications, and doctors. Nearly 1000 providers are now contracted to use Navigating Cancer, and >500,000 patients are in the database. Half of the patients invited to join Navigating Cancer decided to join the portal, and 68% visit the portal more than 4 times per month, according to Ms. Shanahan.

Ms. Shanahan also mentioned GlowCap^®, a lid affixed to the top of pill bottles that lights up when patients are supposed to take the drugs and sends refill requests to pharmacies. A pilot program run by Avella Specialty Pharmacy found that patients who took nilotinib had a 50% increase in medication adherence at 4 months if they used GlowCap^® compared with a control group.

Most FDA-approved specialty medications are now going through a limited distribution network, according to Ms. Shanahan, so pharmacists are participating in dispensing scorecard programs. They are intended to increase medication adherence.

Avella Specialty Pharmacy participated in an adherence study of renal transplant recipients funded by the National Institutes of Health in collaboration with the University of Arizona. Ms. Shanahan said the group receiving interventions had a 12.6% improvement in medication adherence, as measured by the medication possession ratio. Patients who received interventions were 78% more likely to not be hospitalized and saved an average of $27,852 per month in healthcare costs. The interventions varied based on the patients, their disease and drug profile, and their socioeconomic conditions.

“We know that if you get the patient on therapy and you keep them on therapy, you get better results. Those better results lower the costs of healthcare and bend the cost curve,” Ms. Shanahan said.