An Integrated Health-System Specialty Pharmacy Model for Coordinating Transitions of Care: Specialty Medication Challenges and Specialty Pharmacist Opportunities

Abstract

Adherence and persistence to specialty medications are necessary to achieve successful outcomes of costly therapies. The increasing use of specialty medications has exposed several unique barriers to certain specialty treatments’ continuation. Integrated specialty pharmacy teams facilitate transitions in sites of care, between different provider types, among prescribed specialty medications, and during financial coverage changes. We review obstacles encountered within these types of transitions and the role of the specialty pharmacist in overcoming these obstacles. Case examples for each type of specialty transition provide insight into the unique complexities faced by patients, and shed light on pharmacists’ vital role in patient care. This insightful and real-world experience is needed to facilitate best practices in specialty care, particularly in the growing number of health-system specialty pharmacies.

Medication‐related problems in chronic inflammatory conditions: A pharmacy claims and electronic health record analysis

“…Themes that arose in this exploratory qualitative analysis suggest patients taking specialty medications face a unique set of MRPs that extend beyond those typically faced by patients taking traditional medications 22 . Clinic‐based pharmacists and specialty community pharmacists are critical resources that support care for these patients 23‐25 . Pharmacists serve as experts helping patients navigate the complex insurance landscape for specialty medications including obtaining prior authorizations, ensuring the medication is filled at the correct specialty pharmacy, and helping the patient understand copays and financial support programs.…”

A cross-sectional analysis of persistence to disease-modifying therapies in treatment naïve and experienced patients with relapsing multiple sclerosis at a health-system specialty pharmacy

“…The high number of DMT switches due to insurance change highlights the importance of health-system specialty pharmacists and pharmacy technicians during financial transitions of care, which has been previously described. (Zuckerman et al, 2019) Due to the nature of being integrated into the healthcare team, health-system specialty pharmacists manage patients throughout their treatment journey rather than only when taking a pharmacy-dispensed specialty medication.…”

Effect of clinical pharmacist interventions on cost in an integrated health system specialty pharmacy

“…Compounding this, patients on these medications typically have complicated diagnoses and conditions, thus, rendering them vulnerable to dose interruptions, modifications, or changes in therapies. 4 Although the vast majority of specialty prescriptions are serviced by pharmacy benefit managers and their associated preferred pharmacies, specialty pharmacies with an integrated health system model may be advantageous in that clinical pharmacists are able to access medical records, assess therapy plans, and communicate more efficiently with the health care team. 5 Several studies have documented that an integrated specialty pharmacy improves patient compliance and patient and provider satisfaction.…”