The Importance of a Robust Clinical Model for Specialty Care

A recent survey of pulmonary hypertension prescribers’ experiences with specialty pharmacies uncovered some key themes for plan sponsors to consider.

Specialty pharmacies serve patients with complex conditions that require high-cost, high-touch medications. Beyond fulfilling and administering treatments, they also provide care services to help ensure patient safety, effective treatment and appropriate utilization.

The clinical model specialty pharmacies use to guide their care services can vary. However, all should share the same patient-centric approach—one that focuses solely on clinical factors, absent of cost considerations and other business interests. This clinical-first approach is critical in the specialty space, where medication adherence can sometimes be a life-or-death matter and each condition comes with its own set of unique, often complicated characteristics.

Findings from a survey of pulmonary hypertension prescribers on specialty pharmacy experiences

So, what makes one clinical model more effective than others? A national pulmonary hypertension (PH) advocacy organization uncovered some insights in a 2022 survey of PH prescribers about their experiences with various specialty pharmacies. While the survey was specific to PH care, its findings reinforced several common issues seen across the full spectrum of specialty conditions. 

  • Insufficient communication – Weaknesses within the communications infrastructure of some specialty pharmacies, such as an inconsistent point-of-contact or limited staff availability, can result in time-sensitive patient care decisions being delayed.
  • Knowledge gaps – Lack of specialized knowledge across key areas in the specialty pharmacy care continuum—especially specific disease states and therapies, but also including insurance and financial assistance—can lead to dangerous treatment disruptions and lapses.
  • Operational inefficiency – Problems processing medications—including lengthy processes, rigid prescription refill rules and passive re-authorizations—contribute to treatment delays and lapses, as well as extended hospitalizations in some cases. 

PH prescribers rank Accredo highest among specialty pharmacies

  • On a ranked scale of one to five, where five denotes “excellent,” 72% of prescribers rated Accredo‘s communication at either a four or a five.
  • 82% of prescribers rated Accredo staff’s knowledge of PH and related information at either a four or a five.
  • 78% of prescribers ranked Accredo as the top specialty pharmacy in terms of prescription processing.

What plan sponsors should look for in a specialty pharmacy’s clinical model 

To ensure members have seamless access to the best care, while simultaneously mitigating waste and optimizing savings, plan sponsors should carefully evaluate the clinical model of their specialty drug management partner on an ongoing basis.

When conducting such an evaluation, here are some key criteria to look for:

  • Patient safety, above all else – A steadfast commitment to the safety and well-being of patients should underpin every interaction. This can take the form of assigned patient advocates for each case and direct engagement from specialty pharmacy leadership to bridge gaps and troubleshoot issues.    
  • Streamlined communications and education – Patients and prescribers should not have to work too hard or wait too long to get the answers they need. In addition to modernizing telephonic systems with features like call-back queues, specialty pharmacies should offer an easy-to-use online portal containing real-time case details and educational resources.    
  • Dedicated, specialized customer service – While it’s imperative each care team has deep, condition-specific expertise and experience, best-in-class specialty pharmacies will also build customer service teams around particular disease states. A vital component to this team approach is designated points-of-contact with strong, broad knowledge spanning key support areas—from pharmacy and nursing to benefit verification and billing.   

For a deeper dive on how plan sponsors can assess the holistic value of a specialty partner, download our discussion guide here.

* Survey respondents could not select more than one specialty pharmacy for any given ranking. Those specialty pharmacies holding a rank of four or five were ranked above at least three other well-known specialty pharmacies.