The national dialogue launched with the Acentrus Specialty Conference in January 2021 continues to grow as health systems advance their strategies for specialty pharmacy. Earlier this month, I joined two Acentrus clients for a Becker’s Healthcare Podcast: Jeff Reichard, System Director of Pharmacy, Specialty and Home Delivery Pharmacy for UNC Health, and Erica Diamantides, Specialty Pharmacy Manager for UW Medicine. A recap of our podcast follows.
What differentiates health system specialty pharmacies from “big box” pharmacies?
“Health system specialty pharmacies provide direct collaboration with physicians and the entire clinical care team, access to EHRs, and vital patient assistance programs,” says Diamantides. “These benefits pull the entire patient journey together.”
For both podcast panelists, the key distinction is the quality of care made possible by integrating clinical and pharmacy care.
“A health system specialty pharmacy can dramatically enhance care coordination for complex medication therapies,” says Reichard. “The internal alignment of the care team is critical to avoiding the fragmentation that occurs when patients are forced outside the health system to obtain specialty medications.”
How can a specialty pharmacy program be an asset to a health system?
As health systems face challenges including reductions in operating revenue, the rise of value-based purchasing, and growing costs for pharmaceuticals, a specialty pharmacy can be a revenue source as well as a trusted center of expertise for patients.
“Specialty pharmacies within health systems enable them to maintain responsibility for their patients’ care,” says Reichard. “This avoids care fragmentation while bringing a source of revenue to health systems.”
“This is a challenging time with value-based and accountable care,” adds Diamantides. “Health systems must optimize their specialty pharmacies to meet these challenges.”
With manufacturers placing drugs into restricted distribution channels, how are health systems accessing these medications for their patients?
“Restricted drug access is a pain point for many health systems, and is it increasing as more manufacturers use this distribution pathway,” says Diamantides. “UW continues to hack away at the issue of access. As part of the Acentrus network, we are creating efficiencies and aggregating data to meet manufacturer requirements.”
Through the negotiation of manufacturer agreements and automation of data requirements, Acentrus is helping to improve limited-distribution drug (LDD) access for its clients. The Acentrus Advisory Council also has an LDD access committee that is actively identifying and prioritizing market and pipeline LDDs.
“Accessing specialty medications is very different from sourcing drugs in an inpatient setting,” says Reichard. “Let’s say there are 300 medications in the specialty pharmacy channel and 200 to 250 are actively available through open access. Manufacturers have chosen to limit distribution for the remainder. Gaining access is difficult and requires significant effort. Acentrus is helping with contracting requirements, one of the biggest being data sharing.”
LDD access is a challenge, but access to payer networks may be an even greater issue. How are health system specialty pharmacies meeting the challenge of reimbursement?
“Payer network access is a challenge—how to get reimbursed, especially with the vertical integration of plans,” says Reichard. “It’s a slow process but health systems have unique strengths that chain specialty pharmacies do not, including proximity to the patient, a close connection to the patient’s providers, and all the services associated with the continuum of care.”
Acentrus is addressing the issue of payer access through initiatives such as the new Therapeutic Specific Outcomes Coalition, which is capturing disease-specific analytics on the outcomes associated with new drugs.
How are networks like Acentrus helping health system specialty pharmacies meet data challenges?
UNC Health is among the many Acentrus clients now working with data partner Loopback Analytics to deliver data to manufacturers, develop new benchmarking capabilities, and produce outcomes analytics that build the case for the specialty pharmacy programs in health systems.
“We participate in Acentrus data feeds, which has helped us build workflows into EHRs,” says Diamantides. “We are also collaborating with other network members to benchmark, both anecdotally and formally.”
“Through Acentrus and Loopback, we’re working with an advanced platform for data analytics,” says Reichard. “Data mining allows us to work with our stakeholders more effectively. It’s a game-changer because these tools accelerate data collection and analysis, and reduce the burden on our IT team after the feeds are set up.”
Can health systems build and manage specialty pharmacies without relying on outside management companies?
“A network like Acentrus provides assistance and guidance to help health systems operate specialty pharmacies, recognize opportunities, develop strategies, and retain significant revenue potential,” says Diamantides.
“It’s about utilizing internal talent, maximizing output, evaluating internal capabilities, and determining the best model for growth,” says Reichard. “Specialty pharmacy is not a stand-alone endeavor—it requires engagement from health system leadership. It’s a unique business model that involves a small number of drugs with very high margins. It’s resource-intensive and highly competitive. Health systems have the strategic advantage but they need to do a better job of communicating their value proposition.”