Specialty medications are not only used to treat complex conditions, they are themselves complex in nature. Some have complicated dosing schedules, others need to be stored at particular temperatures, and many require self injection and other requirements beyond traditional medications. Because of this, it is common for manufacturers to release specialty drugs to limited distribution networks (LDDs).
With an LDD, pharmaceutical manufacturers select an exclusive network of pharmacies that can demonstrate their ability to achieve the highest clinical standards, including knowledge of the disease state the medication treats, the ability to properly handle and store the medication, as well as provide patient monitoring, education, support and care, which is needed to optimize the treatment.
Restricting distribution to a limited set of pharmacies helps the manufacturer better manage potential drug safety events, costs, the member experience and reporting requirements. The LDD network can vary in size from a larger network of mostly specialty pharmacies to just one or two specialty pharmacies. There are over 400 unique LDD medications and no single pharmacy has access to all LDDs. Adding to the complexity, many LDDs are reimbursed on both the pharmacy and medical benefit. It's not easy for payers, prescribers and members to know where to go for these medications. These individuals need a solution for locating a pharmacy that can dispense the needed specialty drug, while providing optimum care and cost controls.
Elixir’s Approach to the Member Experience
While our own Elixir Specialty Pharmacy has access to many LDDs, there are times when another specialty pharmacy needs to be utilized to provide access to other medications. Through an extensive selection and credentialing process, Elixir has partnered with specialty pharmacies to create the Elixir LDD Wrap network. We partner with specialty pharmacies that can provide access to LDD medications and ensure a comprehensive member care experience, discounted pricing and clinical solutions. Additionally, each of our selected LDD partners offer comprehensive case management for the specific condition being treated and are required to provide reporting on the outcomes, giving payers additional insights.
With this unique and comprehensive network of limited distribution pharmacies that complement the available Elixir specialty pharmacy, we have created a seamless experience for some of the sickest members taking hard-to-find medications. There is clear communication to the pharmacy with direction on where the member must go to fill their prescription, instead of the member searching for a pharmacy on their own. With the majority of specialty medications requiring prior authorization (PA), we have enhanced the PA process to improve communication between the prescriber and the LDD pharmacy, resulting in a streamlined onboarding process. All of this reduces the time to fill the medication and limits any confusion or additional steps for the member.
To improve cost controls, Elixir has negotiated meaningful discounts and other service level expectations with the pharmacies to drive clinical outcomes that help eliminate waste and minimize costs from complications of therapy. All participating pharmacies offer interventions and clinical solutions that minimize cost and health complications.
With these strategic partnerships, Elixir is able to provide a seamless experience for members taking LDD medications. This crafted solution unravels the complexity of LDDs, optimizing care, while providing comprehensive cost controls for our clients.