Sanford Health, the nation’s largest rural health care system headquartered in Sioux Falls, South Dakota, prides itself on ensuring that its high-quality health care services are readily available and accessible to its patients.

Until recently, getting access to certain limited distribution drugs (LDD) manufactured by Pfizer, Inc. was a challenge for Sanford. Being able to offer Pfizer-limited distribution oral oncolytics to oncology patients through the system’s specialty pharmacy in Fargo, North Dakota, is an important component of the Sanford cancer program’s commitment to provide a full range of coordinated care.

“Patient access to health care is a really big DNA marker of who we are as an organization,” said Nate Leedahl, PharmD, lead pharmacist for enterprise pharmacy at Sanford. “Because we did not have access to the Pfizer LDDs, our large population of oncology patients were receiving treatment from us locally, but their pharmacy care was essentially being sent away to ‘big box’ pharmacies or to mail-order specialty pharmacies in distant parts of the country that did have access to the Pfizer oncolytics.”

He added, “We believe nothing compares to the local pharmacy services we provide. We know our patients. Through our EMR, our pharmacy staff can communicate directly with our patients’ providers and access their treatment plans. We believe integrated care, including specialty pharmacy services, is a huge benefit to our patients.”

Sanford Health and Acentrus Specialty

Sanford became an Acentrus Specialty client in August 2018 to help its specialty pharmacy program gain access to the Pfizer LDDs.

“We had a robust, longtime relationship with Vizient (Acentrus’s parent company), so going with Acentrus just made a lot of sense to us,” Dr. Leedahl explained. “After talking to the Acentrus team, they were clearly on the same page as us and shared our goals. It seemed like a natural partnership.”

Within six months of engaging Acentrus’s support, Sanford achieved the data reporting and other clinical and operational requirements that qualified it for access to the Pfizer limited distribution network.

Key to achieving this access was Sanford’s ability to show that its pharmacy and health system offered the required quality and scope of oncology care.

“It was critical to demonstrate that we have an excellent cancer care program, with some mileage on it, and that we have a well-performing pharmacy with an excellent fulfillment rate,” Dr. Leedahl explained. “The challenge for us, as it is for many health systems, was that the historical data had to be provided for a period of two years. We knew we have the required volume of patients, but we didn’t have the other required data covering the two-year time period readily available. Acentrus really worked with us to develop the necessary reporting and processes and make sure we got that data represented.”

The Acentrus team also worked closely with Sanford staff to ensure that the Pfizer-required data they were collecting was accurate and complete. This involved capturing data from several different Sanford clinical systems, formatting and merging it with the Sanford pharmacy dispensing system before sending it to Acentrus to prepare for submission to Pfizer.

“Prior to Acentrus, we didn’t do a lot of reporting out of our software in the retail setting,” Dr. Leedahl said. “This was a new frontier for us. Acentrus helped us identify all the data points that we needed to collect and reformat our clinical data, so it supported our application to join the Pfizer LDD network.”

Jeff Rotar, senior business intelligence report developer for Sanford led Sanford’s IT team for the project. “Acentrus helped us understand what data was validated and which data fields had not been populated and needed to be updated,” he said.

Another valuable contribution by Acentrus, according to Rotar, was introducing Sanford to one of its health system clients who had recently completed a similar project. The connection was especially helpful because the other system utilized the same retail pharmacy software as Sanford and was willing to share lessons learned from its successful project.

“(The Acentrus client) provided a lot of valuable information and answered our queries,” Rotar said. “That communication and that willingness to share their knowledge was instrumental in helping us figure out how to move ahead. It really was a group effort.”

In addition to helping Sanford with the collection and formatting of the required data, Acentrus provided invaluable assistance with completing other potentially time-consuming requirements.

“It’s not just about your data reporting,” Dr. Leedahl said. “You’ve also got to have signed agreements. You’ve got to have a secure data feed link. You’ve got to accurately represent your clinical capabilities. You’ve got to have the right accreditations. And you can’t wait to complete all those things one at a time, in succession. If you start on them only after you’ve got your agreements approved by your legal department, that’s going to delay you another couple of months. Through Acentrus, we were able to get more quickly from point a to point b.”

Results and Lessons Learned

On Feb. 1, only six months after first engaging Acentrus, the Sanford specialty pharmacy was eligible to begin dispensing nine Pfizer oral oncolytics to its cancer patients.

“The timeliness with which Sanford was able to complete the process really is a reflection on the commitment and diligence of the health system,” said Robert Scholz, RPh, MS, MBA, the account implementation director who led the Acentrus team. “Clearly, this project was a priority for Sanford and they were willing to dedicate the resources to push it through. One of the keys to their success was the strong, knowledgeable leadership provided by Nate and Jeff.”

The two men brought complementary skills and expertise to the project. “I was able to translate things from a pharmacist’s perspective to Jeff, and he was able to educate me on the technical data reporting aspect of the project,” Dr. Leedahl said. “By crossing over operational lines, we demonstrated the strength of the collaborative relationship between pharmacy and data analytics at Sanford. I think that’s a critical consideration for other health systems looking to gain access to LDDs.”

“You have to be willing to develop relationships and ask questions,” noted Rotar. “Nate and I both learned a lot from this process, mainly by not being afraid to ask questions. For me, it was an education in pharmacy. It also taught me the importance of familiarizing yourself with your database beforehand and understanding how different fields link together and how that translates to the medical records system. The main thing is to just be committed. This was a high operational priority for our organization, so we worked twice as hard to get it done.”

The results have met all Sanford’s goals and expectations. The health system not only receives additional revenue from being able to dispense the Pfizer LDDs through its own specialty pharmacy, but most importantly, it is now able to provide these often life-saving medications directly to cancer patients.

“We’re seeing a patient population being served by these LDDs that we would never have been able to serve locally before,” Dr. Leedahl said. “Our specialty pharmacy manager and her staff in Fargo are able to provide a very personal high level of service for the patients of Sanford Health – they’re not just lines on a report to them. These are real people, real families, who are so happy now to be able receive their drugs right here. It’s a tremendous patient satisfier when they can receive their care, including their drug therapy, from the same health care team.”

He added, “I think that’s ultimately what’s most special about this project for us. It’s why we all pursued healthcare as a career in the first place – to make a difference.”