Reprinted from SPECIALTY PHARMACY NEWS, a monthly newsletter designed to help health plans, PBMs, providers and employers manage costs more aggressively and deliver biotechs, infusibles and injectables more effectively.
As the specialty pharmacy industry has evolved, it has experienced varying levels of innovation. After a recent lull, the industry seems to be in the midst of a resurgence, according to a speaker at the 21st Annual Meeting & Showcase of the Academy of Managed Care Pharmacy (AMCP). Held in Orlando, FL, April 15-17, the conference included a presentation by Bill Sullivan, president and founder of Specialty Pharmacy Solutions, LLC, assessing of the top 10 innovations in the current specialty pharmacy marketplace.
In the mid-1990s, the specialty pharmacy industry was highly innovative, said Sullivan. Companies were developing new services and programs to meet an also rapidly emerging marketplace demand. But then as the market entered its mid-stage of growth in the late 1990s through early 2000s, payers began to react to cost concerns, and the pace of innovation slowed down as reimbursements started to shrink, he said.
“The stagnation of innovation during that period was not unlike that of the U.S. auto industry, which lost its franchise because of a lack of innovation,” contended Sullivan.
But now, he said, “the specialty pharmacy market is demonstrating a renewed level of innovation. Specialty pharmacies and other service providers are now seeking ways to enhance the value proposition of specialty pharmacy and restore programs and services that will once again differentiate this industry.”
Sullivan illustrated the point by offering examples of specialty pharmacies that he determined were offering innovative services. In his search for the companies that eventually made the cut, he said he reviewed almost 100 organizations. Many of them offered information on “truly innovative initiatives” that “unfortunately, were not yet ready for unveiling,” he added. Such initiatives, he said, served only to “reaffirm the newness of the resurgence” and underscore the fact that “some exciting things will further ignite the market later this year and next.”
Here is Sullivan’s list of the top 10 innovators within the specialty pharmacy industry (Full disclosure: Sullivan has worked with all of the companies on this list except for Specialty Pharmacy Nursing Network, AssistMed, Inc. and P4 Healthcare LLC):
(10) Tie — Diplomat Specialty Pharmacy and Commcare Pharmacy:
Diplomat developed a proprietary IT platform that fully integrates dispensing and medication therapy management with electronic prescribing and electronic medical records, “perhaps the first specialty pharmacy to achieve this important milestone,” he said. Commcare developed a proprietary IT platform with dynamic functionality to support both physician relations and manufacturer-specific initiatives offering actionable product management insights.
(9) Specialty Pharmacy Nursing Network:
This company launched in 2008 to meet a growing clinical concern — access to skilled specialty infusion nursing.
(8) Armada Health Care LLC:
The 150+ specialty pharmacies that participate in the Armada network can seamlessly transfer prescriptions via an electronic portal when they encounter a payer lockout or limited distribution obstacle, often saving hours and even days of delays, Sullivan said.
(7) US Bioservices:
A division of Amerisource-Bergen Specialty Group, this specialty pharmacy company is leading an initiative to combine the diverse service programs offered by other AmerisourceBergen Specialty Group divisions (e.g., Lash Group) into a seamless service offering with one point of contact and one contract.
(6) ChronoMed LLC:
A division of ChronoHealth LLC, this provider offers pharmaco-nutritional, chronic disease-specific products through specialty pharmacies for 16 conditions, including cancer, rheumatoid arthritis, multiple sclerosis and infertility, with more in development (SPN 4/09, p. 12). Such an offering, Sullivan said, is “the missing element” in comprehensive medication therapy management programs.
(5) Sanovia Corp./TriZetto Group, Inc. partnership:
In January, the organizations coupled Sanovia’s IT technology with TriZetto’s broad, robust medical claims database to enable clinically informed prior-authorization reviews based on a patient’s actual history.
(4) P4 Healthcare oncology programs:
These programs integrate P4-administered and payer-endorsed pathways into the oncologist marketplace with proactive communication, education and significant financial incentives for positive patient adherence.
(3) AssistMed:
This company enables interactive Web- or cell-based personalized plans of care for any drug regimen and behavioral program. This solution provides granular data collection, analysis and reporting. More importantly, said Sullivan, the program can be set to trigger interventions, and it seamlessly connects the entire care team.
(2) Centric Health Resources, Inc.:
This new distribution model for specialty pharmacy opens a totally new approach to how specialty pharmacy drugs can be brought to market. By incorporating a manufacturer-direct approach. the specialty pharmacy provides unbundled a la carte clinical and cognitive services and never takes ownership of the product.
(1) The Walgreen Co./Triessent specialty pharmacy program:
Triessent, the specialty pharmacy program from Prime Therapeutics LLC, joined with Walgreens to launch the first totally unbundled program known to date. Triessent has insourced a variety of traditional specialty pharmacy functions, including front-end functions such as referral intake, insurance verification, data entry, prior-authorization coordination and utilization management. And Walgreens provides only outsourced dispensing, clinical management, shipping and refill management. As payers seek to contract with specialty pharmacies, said Sullivan, this new model may set a new standard for a la carte pricing and restore value appreciation for many integrated services that have become commodities over the past decade.