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A challenge for health-system specialty pharmacies
Little Things Can Cause Big Issues in Patient Care T
he patient—a woman with a neuroendocrine tumor—had waited at Baystate Medical Center’s infusion center for three hours. The lanreotide (Somatuline Depot, Ipsen) injection for her tumor treatment had not arrived from the out-of-state third-party pharmacy mandated by her insurance. No one at the hospital could trace it. The drug was reordered and the patient’s treatment had to be rescheduled. Although she received her treatment, the delay could have compromised her care. In another case, IV immune globulin was scheduled for delivery at a specific address at the Baystate campus so it could be signed for and then walked over to the integrated specialty pharmacy, but it did not arrive. It was later discovered that the third-party drug supplier had used the wrong address. (Baystate is a large system in western Massachusetts and has multiple addresses.) Eventually, the drug was found and delivered, but the amount of time and effort expended because of a clerical error was enormous and caused significant distress to the patient. Although much attention has been given to treatment delays caused by prior authorization hurdles, sometimes patient care in specialty pharmacy is interrupted by simple clerical errors such as those in the cases above. While treatment in both cases was ultimately rescheduled as soon as possible and shipping addresses and contact information were updated, the problems could have been avoided, said Gary Kerr, PharmD,
the chief pharmacy officer at Baystate Health, who noted that the health system tries to gain access and control of the shipping process so it can provide the drug directly whenever possible. “The things that derailed treatment in these two cases were all little things. It’s basically logistics—packing, shipping and delivery issues—especially when the drug is mandated by a payor or PBM [pharmacy benefit manager] to be sourced from a supplier in another state or region. Once we have the drug in our possession, the process typically runs very smoothly.” On a more systemic level, Dr. Kerr added, “it’s about providing more patient access and choice. We have found it makes a dramatic positive impact on the entire therapy delivery process, and more importantly, on patient care.”
Beware of ‘Handoff Gaps’ Like many health systems, Baystate Health has a state-of-the-art integrated specialty pharmacy and is not immune to the industrywide challenges posed by drug delivery channels mandated by payors and/or PBMs. When a drug is sourced from out of state, out of region or even simply outside of preferred channels, there is a higher risk that these “handoff gaps” will occur, said Dr. Kerr, who noted that Baystate tries to work with insurance companies to reduce restrictions that limit where prescriptions can be filled. “Our pharmacy is literally 100 yards from our cancer center, and 25% of the patient panel in our integrated
specialty pharmacyy is from the cancer center,” he said. “How does it make sense that we are forced to purchase a drug from a supplier plier in Houston or Miami when I could uld walk outside my door, throw a rock and hit the cancer center? When hen we supply the drug ourselves, s, if a physician writes an order at 3 p.m. Eastern time on Monday, we could start therapy on Tuesday or, worst case, on Wednesday.” When it’s allowed d to work as intended, the integrated specialty pharmacy model at Baystate has reduced fragmentation in care and improved d patient outcomes across a number of metrics. According to internal data, time to start therapy erapy in one study was cut in half lf (now averaging 2.2 days); prior authorization rization turnaround time was reduced to o less than a day; and clinical metrics across oss a number of disease states improved. d. “Our multiple sclerosis lerosis relapse rates are world-class, with th more than 87% of patients reporting zero flares,” Dr. Kerr added. “For our patients ents on HIV therapy, 91% have achieved d suppression, while 97.2% of our hepatitis titis C patients have achieved sustained viral response. In oncology, 5.3% of our patients on service have had ED [emergency department]
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visits or hospitalizations related to their cancer diagnosis—significantly below the national benchmark.” To bring attention to the quality of care delivered by health-system specialty pharmacies, Baystate and a number of other health systems launched the Health System Owned Specialty Pharmacy Alliance (HOSP) in October 2020. This nationwide organization of leading health systems is specifically focused on the interests of health-system that own specialty pharmacies. They advocate for an integrated model, set best practices, work on technology solutions and bring attention to key operational and clinical challenges faced by members. In addition to Baystate Health, some of the other health systems involved in HOSP leadership include Minnesotabased Fairview Health, New York’s Northwell Health, the University of Massachusetts Memorial Medical Center and WVU Medicine in West Virginia.
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