How Specialty Pharmacies Connect the Dots for Patient-Centered Care

Specialty pharmacists are able to coordinate services and address social determinants of health, leading to improved medication adherence and health outcomes.

Specialty pharmacies play a pivotal role in ensuring patients have access to the proper medications and resources necessary to stay adherent. They have evolved to handle the complexity and costs of specialty pharmaceuticals while at the same time managing reimbursement and providing individualized clinical support to patients.

Within the concept of patient-centered care, these pharmacies function as the lynchpin bringing together manufacturers, providers, payers, and caregivers to streamline a process aimed at achieving optimal health outcomes for patients. And the value of specialty pharmacies has become especially evident during a pandemic that has disrupted daily life and exacerbated many of the social determinants of health that prevent patients from staying healthy.

“Pharmacists are in the center of the community,” says Stacy Ward-Charlerie, Director of Product Development Solutions at AllianceRx Walgreens Prime. “They’re seen as a healthcare professional that’s accessible and because of that, they’ve built trust with patients. As the specialty patient population is typically more vulnerable and requires more care, and as access increases through telehealth and other digital media, we have also seen trust maintained or even strengthened in a central specialty pharmacy model."

In many ways, the very nature of specialty pharmacies makes them ideally suited to addressing social determinants of health that affect a patient’s health, functioning, and quality of life. According to Pharmaceutical Care Management Association, specialty pharmacies fulfill their role by offering both clinical and operational services. The former includes access to providers, physician consultations, care management, clinical outcome reporting, patient adherence programs, and contribute to drug safety programs. The latter entails supply chain management, care coordination, insurance navigation, patient assistance, and plan optimization.

“In the world of specialty where there are complex disease states, there are unique financial, operational, and clinical pieces to providing services to patients,” Ward-Charlerie adds.

By offering this array of services, specialty pharmacies can serve as genuine connectors focused on identifying solutions to the many problems their patients are likely to face.

Economic stability is one social determinant of health that the pandemic has magnified, and specialty pharmacies have been able to find solutions by working collaboratively with providers, payers, charitable foundations, and pharmaceutical companies.

Behind the scenes, specialty pharmacies coordinate with payers and providers to streamline the process for approving and dispensing medications to patients as well as working with pharmaceutical companies to ensure the availability of these medications. “That includes working with providers to secure prior authorizations, with denials especially, and providing patients with financial assistance when economic stability is a factor. Whether it’s a coupon from the manufacturer or a charitable group, we do our part so that patients can get their medication,” says Ward-Charlerie.

Meanwhile, pharmacy staff remain focused on patients, remaining empathetic to the latter’s unique needs and providing clear communication along their healthcare journey.

“Once the patient has received and started therapy, we continue to monitor the patient through their treatment journey assessing for desired therapeutic outcomes, side effects, and adherence,” explains Ward-Charlerie.

Provider communication is vital if patients are unable to adhere to their medications for any number of reasons.

“The provider needs to be kept in the loop because if anything changes along the way, they need to be aware and take necessary steps,” Ward-Charlerie maintains. “That could mean a return to the doctor’s office in a week’s time or getting the patient to the hospital because  missed doses could prove detrimental to the patient’s condition.”

But the work of specialty pharmacies doesn’t end there. Innovators in the space have taken the initiative to provide additional wrap-around services to patients to address the whole person by addressing directly or sharing any social determinants of health factors with payers, providers, or manufacturers who may have additional programs and services to offer the patient.

It’s all part and parcel of today’s specialty pharmacy that comprises pharmacy technicians, patient care advocates, financial services staff, and benefits specialists. The combination of clinical and operational services positions specialty pharmacies to assist patients through their treatment journey to deliver truly patient-centered care.

With the coronavirus pandemic continuing to threaten the health and well-being of individuals and communities where social determinants of health are pervasive, specialty pharmacies can sit in the middle of manufacturers, providers, payers, and patients to achieve positive health outcomes for individuals with complex conditions.