By COLLEEN SCHRAPPEN
The good news in treating chronic diseases such as HIV, hepatitis C, multiple sclerosis, cancer and rheumatoid arthritis is that there are more specialty drugs on the market than ever before — about 300 today compared to 10 in 1990. Another 800 or so specialty drugs are currently in the pipeline.
Audriana Sanchez, a specialty pharmacy technician, at work in the specialty pharmacy at St. Joseph Hospital and Medical Center in Phoenix where Dignity Health launched a program to provide outpatients with chronic conditions ongoing personal support. Courtesy of Dignity Health
But for many patients, even those with insurance, these specialty pharmaceuticals are unaffordable. Although only a small fraction of patients are prescribed the drugs, specialty pharmaceuticals have been the main driver of U.S. drug spending increases over the past few years. According to several analyses, per capita spending on specialty drugs rose by 55 percent from 2013 to 2016.
Though there is not a hard-and-fast definition for specialty drugs, they typically target serious, chronic diseases and can deliver life-altering benefits or even cure select diseases. The category includes biologics, which are derived from living cells; many of the compounds are infused or injected. The average annual wholesale cost of certain specialty drugs can run in the low six figures.
Medicare defines specialty medications as any drug that costs $670 or more per month, and it puts them in a tier that carries a significantly higher co-pay for patients. The Kaiser Family Foundation says that Medicare Part D drug benefit enrollees can be on the hook for several thousand dollars in annual out-of-pocket costs for select specialty drugs.
According to the Pharmaceutical Care Management Association, specialty drugs most often share these characteristics:
- Prescribed for complex, chronic medical conditions or rare diseases
- Require additional patient education, adherence or support
- Have unique storage or shipment requirements
- Are not stocked at a majority of retail pharmacies
To address these difficulties, San Francisco-based Dignity Health, part of the CommonSpirit Health system, has launched Dignity Health Specialty Pharmacy, a joint initiative with Shields Health Solutions. The specialty pharmacy offers patients with chronic conditions ongoing personalized support and access to select specialty drugs with an average co-pay of $10.
Shields Health Solutions, based in Stoughton, Mass., partners with Dignity Health and other health systems to help them build specialty pharmacies. In addition to providing complex medication, a specialty pharmacy can play an active role in managing patient care, providing patient support by answering questions and listening to concerns for the duration of the patient's treatment. It is an approach to patient care that has become more common as the complexity and cost of specialty drugs have continued to increase.
"For us, it's all about the patient receiving the care they deserve, really being there on the touch points along the continuum," said Marla Weigert, a senior leader in pharmacy revenue services for CommonSpirit Health and president of the Dignity Health Specialty Pharmacy.
Weigert said that Dignity Health providers had noticed that when their patients were discharged after receiving a diagnosis of cancer or undergoing an organ transplant, for example, there was often no way of knowing whether the patients had their prescriptions filled or were following through with their treatment plans.
Sometimes, patients can't afford the drugs, she said. Other times, they are so overwhelmed by the diagnosis that they fail to get the prescription filled. Or they start on the drug regimen, experience a side effect, and stop taking it.
Under Dignity Health's program, which started at St. Joseph's Hospital and Medical Center in Phoenix in July 2018 and expanded to Sacramento, Calif., in March, patients develop a relationship with a pharmacy liaison who guides them through their treatment plan.
The program employs about a dozen liaisons, who are pharmacy technicians with specialized training, Weigert said. As the program expands, more liaisons will be brought on board. The liaison checks in with each patient about four times a month; if there is a problem, the liaison connects the patient to the care provider for follow-up.
Drugs are dispensed through the outpatient St. Joseph's McAuley Pharmacy on the Phoenix campus, with delivery to the patient's home in an average of 48 hours, Weigert said. Patients can get their specialty drug prescriptions filled along with any standard retail medications they may be taking.
But they also can choose to order their drugs from their regular pharmacy and still receive the ongoing support from
Under a new service being rolled out in select markets by Dignity Health, patients requiring specialty pharmaceuticals will be able to receive ongoing personal support from pharmacy liaisons. Courtesy of Dignity Health
The partnership with Shields Health Solutions, which calls itself a specialty pharmacy integrator, provides Dignity Health with the "expertise and infrastructure to set up and eventually expand the program," Weigert said. "They have been our educator, guide and adviser in putting the program in place."
The specialty pharmacy also includes a 24-hour call center staffed by clinical pharmacists.
As of June, about 12,000 scripts had been filled through the specialty pharmacy.
Dignity Health plans to bring another six markets into the program this year. Anyone can use the specialty pharmacy, but commonly, patients become aware of it through physicians or clinics within the CommonSpirit Health system.
Long-term plans include expanding the program throughout Dignity Health's 41 hospitals in Arizona, California and Nevada and other CommonSpirit Health markets, particularly in places where it may be difficult to access expertise on specialty pharmaceuticals.
The Pharmaceutical Care Management Association predicts that specialty pharmacies will help save an estimated $250 billion on the cost of specialty drugs and related expenses over the next decade.
Weigert said that for Dignity Health, the priority is creating a better health care experience for patients and an expectation that their treatment outcomes will improve under the program.
"I just think the model is fantastic and what it does for our patients is fantastic," Weigert said.
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