Developing a Competitive Specialty Pharmacy

Background: Specialty pharmacies provide quality services to a limited population of high cost, complex patients. Developing a specialty pharmacy can provide health systems with an opportunity to integrate healthcare information for their high-risk patients and provide high quality outpatient pharmacy services. Two challenging aspects of developing a specialty pharmacy are obtaining access to medications that may be part of limited distribution channels, as determined by drug manufacturers, and securing contracts with health plans. As more health systems invest in these services, identifying services essential to remaining competitive in the increasingly populated market would be valuable to both new and existing specialty pharmacies. Objective: Within an identified therapeutic category, develop guidelines for implementing a competitive specialty pharmacy with regards to requirements of health plans and drug manufacturers. Methods: Preliminary research from case studies, market experts and presentations was conducted to identify potential methods for developing a specialty pharmacy. The need for clinical management, access to medications and contracts with health plans were identified as crucial areas for success. A targeted disease state was selected to serve as an example for establishing a successful specialty pharmacy practice. A literature review of this disease state was used to develop clinical management guidelines, and to identify drug companies for specialty medications with an FDA indication for this disease. Health plans with a presence in the Memorial Hermann market were selected and interviewed to determine their needs for providing specialty pharmacy services. The information gathered from health plans and drug companies was organized into essential domains and metrics to provide a guide for developing a specialty pharmacy. Results: The clinical information gathered in the literature review was developed into clinical management guidelines, and the information from health plans and drug companies was organized into essential domains and metrics to provide a guide for developing a specialty pharmacy. Conclusion: Measuring the quality of services provided with targeted metrics demonstrates the value of a specialty pharmacy to health plans. Developing services in the identified domain service areas and correlating metrics to measure the quality of each service provided will present the specialty pharmacy