With the growing specialty drug pipeline that is contributing to nearly half of overall drug spend, we have been discussing strategies for managing these costly medications in a four-part series.[1] So far we’ve covered the importance of monitoring drugs before FDA approval and determining formulary placement, proper utilization management strategy, and how budget impact modeling can help a plan prepare for new specialty medications coming to market.
As the last step in managing specialty medications, plan sponsors must ensure that their members are getting individualized care from the specialty pharmacy in order to get the most benefit from these complex medications, minimize waste and alleviate additional costs from other healthcare complications.
The complexity of specialty medications can lead to a number of questions or hurdles that members taking these treatments need assistance with, including:
- Proper Storage and Handling – Some medications need to be kept at certain temperatures or stored under specific conditions. There also might be protocols to follow when administering the drug.
- Administration Technique – Many specialty medications are self injected. Members might require assistance on proper injection techniques or may benefit from tips to avoid injection fatigue, miss fires and medication wastage.
- Complicated Dosing Schedules – With some specialty medications, complicated dosing schedules can cause confusion for members. For example, loading doses and adjuvant therapies may require different dosing strengths, quantities, frequencies and even dosage forms prior to converting to long-term maintenance treatment.
- Side Effects – There are various side effects that individuals may experience while taking specialty medications, some that may be intolerable. Providing advice for managing side effects or starting treatment at an appropriate time can help individuals overcome side effect hurdles and remain on therapy.
- Costs – Just as specialty medications are expensive for plan sponsors, they are costly for members too. Members often need financial assistance to afford their prescription.
- Individual Response – Many of the conditions that specialty drugs treat manifest differently from person to person and each individual’s response to treatment is different. Condition-focused controls ensure the right treatment plan for the member and continual monitoring is essential to ensure optimal outcomes from the therapy.
A High-Touch Care Model
Beyond simply dispensing the medication, Elixir Specialty provides an individualized care model that provides support to members before, during and throughout treatment to optimize outcomes.
Prior to Treatment – Elixir Specialty’s certified specialty and often disease-certified pharmacists work directly with members before shipping the first dose of a specialty medication to ensure their readiness to start treatment and their overall commitment to the regimen, determining where the member is in their treatment journey and identifying any potential barriers to care. We educate the member on what to expect from their treatment, potential side effects and drug interactions, and discuss any key points that can affect therapy.
For certain conditions, a pharmacy specialist performs a readiness screening to determine if the member would benefit from an alternate start date due to other illnesses or to lessen the impact from side effects on daily living. This helps improve adherence, which is crucial for most specialty medications.
For those receiving injectable treatment, we link them to a pharmacy staff specialist, available 24/7 for counseling and injection support. We develop customized care plans for the member, which are condition and drug focused, with the pharmacist spending 20-30 minutes or more with the member during this initial assessment.
At the Start of Care – We assess all members at the start of care to determine if copay assistance programs are available, either through the manufacturer, governmental programs or non-profit foundation organizations.
During Therapy – Members receive clinical support throughout the course of treatment. We empower the member’s voice to gain insight into their treatment journey, discover opportunities to mitigate barriers and optimize care. We do this by using a number of different screening tools and questions. It’s more than simply counseling or telling the member they can reach out to us at any time. It’s gauging comfort with therapy. We do this by:
> Screening for issues such as itch, affected body mass and depression
> Evaluating the member’s confidence in their treatment
> Assessing for missed doses and side effects
> Customizing care plans to address issues
> Collecting lab results for appropriate disease states to track therapy effectiveness
> Intervening when needed to help members overcome barriers
All of this is done with a commitment to helping the member achieve their therapy goals.
Elixir Specialty’s dedication to the member is the difference between simply supplying a medication and truly impacting the quality of a member’s life. Knowing that every member’s story is unique, we provide a proactive, hands-on pharmacy approach that is disease- and drug-specific, as well as tailored to each member’s individual needs.
Our care model has resulted in 98% overall member satisfaction scores and 92% or higher medication adherence rates for four costly conditions, surpassing industry benchmarks. These results, as the last step in managing specialty medications, limit waste of pricey drugs and improve clinical outcomes, lowering the total cost of care while helping members achieve whole health for life.
This blog post was written with assistance from Jordan Maddocks, director of clinical services and outcomes for Elixir Pharmacies. Jordan was key and instrumental to our pharmacy growth and success, working with several teams on both the pharmacy and PBM side of the business for the past nine years. Jordan will be sorely missed and fondly remembered.
[{1] Seymore, Brandeis (2020). Challenges of Channel Management for Specialty: Medical Benefit or Pharmacy Benefit. Pharmacy Times. July 10, 2020. https://www.pharmacytimes.com/view/challenges-of-channel-management-for-specialty-medical-benefit-or-pharmacy-benefit.
