Growing and Sustaining a Strong Specialty Pharmacy Program

A successful health system specialty pharmacy (HSSP) program provides many patient care and financial benefits. As a result, there has been a significant increase in the number of health systems that are initiating or trying to quickly expand their HSSP programs. The expansion of specialty pharmacy services provides many quick wins for patients, clinicians, employees and the financial health of the organization. Recent financial pressures have put even more focus on the need for health systems to develop successful internal specialty programs.

Many health systems have a vision for what a formal HSSP looks like based on peer organizations that have grown successfully in this marketplace. The truth is that there are no formal applications or requirements to get started. However, getting an HSSP from infancy to adulthood can have some growing pains, and the model for success is different for each organization.

Regardless of whether you are just getting started, or have an established program, there are strategic efforts that must be considered for hardwiring HSSP success. Undoubtedly, there are internal and external challenges and politics that come along with change. Visante has expertise in and experience with helping health systems accelerate and customize these efforts to achieve quick and sustainable success.

Keys to HSSP Success

1. Build and/or Strengthen Dispensing Services and Workflows

Having a successful HSSP starts with having a strong dispensing pharmacy operation with efficient workflows. Many HSSPs have an outpatient pharmacy, but the mere presence of a dispensing location does not necessarily mean you are ready for growing into an HSSP. Hospital outpatient pharmacies have historically served a specific purpose, providing medications for discharge patients and employees. Oftentimes viewed as a commodity, there may not have been much focus on financials, productivity, resources, or day-to-day oversight. Considerations for space and future growth are also important, as there may reach a point where the existing footprint cannot support a more mature HSSP. As a result, the HSSP journey usually requires starting with a comprehensive review of workflows, efficiencies, and service offerings.

Key areas of focus that need to be considered early on in HSSP development include revenue cycle integrity, data analytics and reporting, and convenient service offerings for patients. Pharmacy departments need strong processes for reporting and tracking profitability. These differ greatly from the systems used elsewhere in the health system as the pharmacy benefit revenue cycle operates in a completely different fashion than the medical benefit. Additionally, outpatient pharmacies tend to have standalone software systems which necessitate growing health system expertise to understand how expense and revenue are captured and reported. As a result, it is a good idea to understand, evaluate, and establish good financial reporting and revenue cycle practices at baseline.

Patient convenience is also different for an HSSP compared to a traditional outpatient pharmacy. Whereas most outpatient pharmacies operate bedside delivery services or convenience offerings for on-site employees, specialty pharmacy requires more outward facing convenience offerings. This is primarily accomplished by mail and delivery services which comes with added considerations for logistics and cold chain shipping. These services become increasingly important with HSSP growth and align with home delivery models seen in other marketplaces.

2. Identify the Opportunities (and Threats)

Which clinics prescribe the most specialty medications? How many of your clinics partner with and utilize external specialty pharmacies? Does your organization have a health plan, and are you able to fill specialty prescriptions for employees? How many resources do your clinics dedicate to prior authorization and patient assistance programs? Which prescriptions are 340B eligible? What products do you have access to? Which disease states are more or less complex when trying to navigate payer step therapy or prior authorization requirements?

These are just a few of the questions that need to be explored to build an HSSP strategy for success, and it is undoubtedly hard to wrap your mind around the many variables that exist in this marketplace. Operating an HSSP requires business acumen that is specific to the pharmacy marketplace and requires learning and expertise in this area. This is where a business partner like Visante can provide quick and significant market intelligence, health system analyses and insight.

Many organizations view access to restricted payer networks and limited distribution drugs as a major initial roadblock. However, it is likely that you have access to fill more than 50% of health system-generated specialty prescriptions at baseline. Quick strategies to capture this open distribution, open network business should be a priority.

Additionally, HSSPs can oftentimes have more leverage when looking internally at the employee health plan. Navigating this process can require some political savvy but getting access to the specialty network (or becoming the specialty pharmacy of choice for the health plan) is a well worth the effort. This ensures guaranteed business and recurring revenue which is important for HSSP sustainability.

3. Prioritize and Execute

“Without strategy, execution is aimless. Without execution, strategy is useless.” While these words of wisdom come from an amazingly successful entrepreneur in the semiconductor industry (Morris Chang), they are extremely relevant to growing a successful HSSP program.

Starting an HSSP requires consideration for additional personnel and resources. These initial investments will pay dividends in their return on investment for the organization. The best tool for improving specialty prescription capture is collaboration with targeted clinics to establish prior authorization services within pharmacy which requires developing and hiring a prior authorization technician(s). This is a win-win, as it allows the clinic to dedicate resources to patient-focused services and aligns the process of navigating the pharmacy benefit within the pharmacy department. By performing the prior authorizations, the pharmacy can market their internal services and recruit patients to fill at the HSSP.

In addition to the core retail pharmacy operations described above, an HSSP program must also consider call center capabilities and expanding pharmacist clinical expertise. As capture rate grows, these services should grow in parallel to meet patient and clinician needs.

4. Overcoming Growing Pains

There are multiple times in the HSSP journey where an organization will encounter roadblocks and barriers. Each challenge is different and unique, with the potential to have significant impacts to a health system’s bottom line. In a volatile marketplace and in direct competition with Fortune 500 companies, an HSSP cannot be successful without the support of the larger health system. The most successful HSSPs have strong endorsement from the health system’s senior leadership team and medical staff leadership, and this is a crucial element to overcoming HSSP growing pains.

As HSSPs grow and become more competitive, having strong internal relationships with legal, informatics, compliance, government affairs, and public relations departments enables the flexibility and nimbleness needed for success.

A Partner for HSSP Success

Health systems are responsible for generating most specialty prescriptions in the marketplace  and health systems should be in network to holistically manage patients on specialty medications. At Visante, we are dedicated to partnering with health systems to grow strong internal HSSP programs. We are different from other marketplace competitors: we want you to achieve self-sufficiency and enjoy the long-term benefits of having a successful HSSP without opportunistic contract fees or arrangements. We believe that the best way to ensure long-term HSSP success and sustainability in the marketplace is for the continued collective growth of strong HSSP programs.