The patient journey in specialty pharmacy can be daunting. That journey, and the Acentrus network’s focus on removing obstacles, is featured in a new Pharmacy Times article, HSSPs Untangle the Journey for Patients With Complex Specialty Diseases, which was inspired by a session I had the privilege of moderating during the Acentrus Specialty Conference in April.
The session, “The Patient Journey: Success Stories in Optimizing Therapy,” featured representatives of four health systems, who shared how their clinical and pharmacy teams are working together from initial diagnosis through treatment to create a seamless journey for patients struggling with hurdles to healing. Highlights of the session follow.
The Specialty Patient Journey: Complexities and Barriers
Myra Pascua, Pharmacy Manager for the UCSF Specialty Pharmacy, described the patient maze that follows an initial diagnosis, from treatment options and care plans to benefit investigations and prior authorizations.
“It’s a complicated system,” said Pascua. “It’s confusing for us as health care professionals, so imagine the confusion it causes for patients.”
Meagan Fowler, Director of Pharmacy Services, Specialty Services and Clinic Operations for UAB Medicine, emphasizes that it doesn’t get any easier when patients begin the next stage of the journey with treatment, lab monitoring, and adherence assessment.
“It’s a maze for patients,” said Fowler. “I think of myself as a guide through the maze. With pharmacists imbedded in clinics, communication is streamlined, turnaround times are lower, and adherence is higher.”
For Lauren Holesh Meekins, Pharmacy Manager for the UNC Shared Services Center, the benefits of comprehensive, coordinated care are evident.
“Specialty drugs have a lot of clinical risks,” said Meekins “Our team is very involved in follow up, interventions, and adherence counseling.”
Specialty Success: Internal and External Strategies
Every panelist concurred that operating a successful health system specialty pharmacy begins with strategic planning, both internally to strengthen operations and externally to strengthen access.
Internal strategies such as wrap-around support services and advocacy help to position patients for success in completing treatment with optimal results — and meeting out-of-pocket costs. “There can be ‘sticker shock’ associated with specialty medications, which are traditionally very expensive,” said Pascua. “Our team has a patient support liaison to help with prior authorizations, grant assistance, and appeals.”
External strategies help health system specialty pharmacies access LDDs, monitor the drug pipeline, and overcome barriers to restrictive payer contracts. Meekins gave the example of a patient who ran out of a seizure medication over the weekend when a mail order prescription from a third-party pharmacy didn’t arrive. Coordination between the health system’s pharmacy and clinical team made it possible to fill the prescription in the interim.
“This is what sets hospital specialty pharmacies apart from external pharmacies,” said Meekins.
A New Model: The Pharmacist as Care Coordinator
The health system specialty pharmacy model places the pharmacist in the role of care coordinator as the patient’s primary touchpoint. Pharmacists imbedded in clinical teams are uniquely positioned to have a comprehensive view of the medications and conditions a patient is navigating.
Lanh Dang, Clinical Ambulatory Care Pharmacist for UF Health Shands Jacksonville, shared a story about a patient with Crohn’s disease she has worked with for six years, from initial evaluation and treatment plan to continuing follow-up care. Recently, when a treatment issue arose requiring an increase in dosage, Dang consulted with the patient’s GI specialist and worked with the insurer to secure approval.
In her role, Dang consults with the clinical team on drug therapies, makes sure patients have the information they need about medications, helps to coordinate refills, troubleshoot side effects, and helps with insurance and co-payment issues as needed.
“Our pharmacists are integrated with clinicians,” said Dang, a multispecialty pharmacist who works in pulmonology, rheumatology, and GI clinics. “I’m the patient’s touchpoint for the entire journey, working alongside providers and assisting with hurdles.”
Pascua describes a similar role at UCSF. “Pharmacists imbedded in clinics can order and analyze labs, manage side effects, and adjust doses,” she said. “It increases efficiency and lowers turnaround times when everyone is working at the top of their license.”
Patient Satisfaction: Care Built on Trust and Advocacy
The panelists concluded by looking at factors that drive patient satisfaction including medication pickup and delivery options, the emergence of digital patient engagement through mobile apps and multiple points of communication, and the proactive management of prior authorization expirations.
While a multitude of variables affect patient satisfaction, Fowler said it often comes down to the role of the pharmacist as the patient’s guide on a journey that can be arduous and confusing.
“It’s about knowing your patient as a whole person,” said Fowler of the growing role pharmacists play in managing care and medically integrating dispensing. “It’s about trust and relationships.”