MID Gains Momentum as Specialty Stakeholders Recognize the Value

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Specialty Pharmacy By the Numbers

I had the pleasure of talking with Marcus Robertson, Assistant Editor at Becker’s Healthcare, about a growing specialty pharmacy model that is delivering better patient care while reducing overall costs. This model, medically integrated dispensing (MID), is already making a difference in the lives of patients.

A recap of our conversation follows. Listen to the full podcast.

Specialty Pharmacy Growth and Trends

As the fastest growing sector of the pharmaceutical industry, specialty pharmacy is in the spotlight. Specialty drug costs now account for more than 50% of the overall U.S. drug spend with only 2-5% of the total patient population using these medications.

Specialty is in the spotlight for all stakeholders, from the manufacturers who invest in developing these drugs to the payors who exert control over how they are dispensed. Caught in the middle are the stakeholders whose lives depend on these medications: patients. For many, the treatment journey can be fragmented and frustrating. But a new care model, medically integrated dispensing (MID), is transforming that journey — and delivering cost savings proving that better care is also better for the bottom line.

A Unique Opportunity for Health Systems

Pharmacy is one of the few health services that touches the lives of many patients every month, providing a built-in opportunity for communication on a regular basis. This contact is especially critical for patients on the specialty medications that have complex treatment regimens. In the growing specialty sector, heath system-operated specialty pharmacies are leaders in providing the care continuum that helps patients successfully navigate their treatment journeys.

In addition, as healthcare services move to ambulatory sites in response to plan sponsors and health insurers incentivizing or mandating alternate sites of care to lower costs, health systems are increasingly looking to specialty pharmacies as a way to serve their patients, retain revenue, and build brand awareness in communities.

Why the MID Model Makes Sense

Large pharmacies owned by vertically integrated companies that manage both health and pharmacy benefits for plan sponsors and self-insured companies dominate the healthcare landscape. But health system specialty pharmacies are making inroads. The growth of MID has increased the momentum for a clear reason: health system specialty pharmacies can provide what central fill pharmacies cannot: local, integrated care.

The MID model involves an integrated care team along every step of the patient journey. Clinic-embedded pharmacists play a vital role as care coordinators. Due to the complex nature of many specialty therapy regimens, patients often need education, monitoring, and continued evaluation for side effects. Clinic-embedded pharmacists also have direct access to electronic health records, which can help the team expedite prior authorizations, speed time to therapy, monitor adherence, and evaluate needed adjustments.

Today, in many health system specialty pharmacies, a clinic-embedded pharmacist works directly with patients as a care coordinator. This practice is growing nationwide.

The Economics of MID: Everyone Benefits

Studies are demonstrating that MID has the potential to lower overall specialty pharmacy costs for a number of reasons including waste reduction. With specialty medications such as those in oncology, waste is often a reality because patient drug dosages or treatment regimens can change.

One study showed a potential average savings of $1,800 per medication dose change at an MID pharmacy, compared to a central fill specialty pharmacy. Another study using similar cohorts of Medicare patients demonstrated a net savings of over $1,000 per patient per month when patients were treated in an MID pharmacy vs. a central fill pharmacy. A third study, using Medicare Advantage patients in 2021 taking oral oncolytic medications, derived similar results, with an estimated savings of about $900 per patient per month.

Clearly the evidence shows that MID pharmacies can lower costs. Over the past year, Acentrus has been collecting data from a group of member health systems to demonstrate conclusively that overall healthcare costs for patients treated in an MID setting are lower than costs associated with central fill pharmacies, where clinical and pharmacy care can be separated by hundreds of miles.

MID is also attracting the attention of pharmaceutical manufacturers because no other pharmacy model provides a comparable level of patient-centered, clinical immersion. Every major manufacturer is invested in the specialty drug market and pipeline, and they are recognizing that MID pharmacies get the right patient on the right medication faster and keep that patient compliant longer than any other model.

The MID Road Map: A Better Patient Journey

Consider the feelings of a patient who has just been diagnosed with a serious illness and is anxious and scared. Imagine putting this patient through the additional stress of confusing requirements for prior authorizations, or restrictions on what pharmacy is allowed. These hurdles and hassles can detrimentally impact the patient experience and, most important of all, patient health outcomes.

A recent article published on Business Wire1 suggests that patient satisfaction with health system specially pharmacies is much higher than the average specialty pharmacy. In addition, the published results of a PBM pilot in October 2021 measuring the benefits of an integrated care approach to cancer therapy found that this care coordination resulted in reduced time to therapy and significantly improved medication adherence.

To put this simply, MID reduces care fragmentation and optimizes outcomes. Patients treated by an MID team receive care that is contiguous, complementary, and synergistic. No other pharmacy model comes close to approximating what MID delivers. The benefits of this approach extend to every stakeholder: drug manufacturers, health systems, providers, payors, and most important of all, patients.

[1]Trellis Rx Achieves A Leading Patient Net Promoter Score in Zitter Insights’ Specialty Pharmacy Patient Satisfaction Survey | Business Wire

Steve Zabriski, MBA, BS Pharm, Acentrus Specialty Senior Director, Payor Strategies
ABOUT THE AUTHOR | Steve Zabriski, MBA, BS Pharm, Acentrus Specialty Senior Director, Payor Strategies
Steve Zabriski has more than 40 years of pharmacy experience in retail and specialty pharmacy operations, managed care, PBMs, clinical services, benefits, analytics, information technology, and sales and marketing. He works with Acentrus clients to optimize their inclusion in payor networks.