An Integrated Health-System Specialty Pharmacy Model for Coordinating Transitions of Care: Specialty Medication Challenges and Specialty Pharmacist Opportunities.

Autumn D. Zuckerman,Tara Kelley,Houston Wyatt,Alicia Carver,Marci Saknini,Amy Mitchell,Brandon Markley,Victoria W. Reynolds,Katrina Cooper

doi:10.3390/pharmacy7040163

Autumn D. Zuckerman, Tara Kelley + Show 7 more

Open Access

https://doi.org/10.3390/pharmacy7040163

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Abstract

Adherence and persistence to specialty medications are necessary to achieve successful outcomes of costly therapies. The increasing use of specialty medications has exposed several unique barriers to certain specialty treatments’ continuation. Integrated specialty pharmacy teams facilitate transitions in sites of care, between different provider types, among prescribed specialty medications, and during financial coverage changes. We review obstacles encountered within these types of transitions and the role of the specialty pharmacist in overcoming these obstacles. Case examples for each type of specialty transition provide insight into the unique complexities faced by patients, and shed light on pharmacists’ vital role in patient care. This insightful and real-world experience is needed to facilitate best practices in specialty care, particularly in the growing number of health-system specialty pharmacies.

Highlights

IntroductionWhile there is no single definition of a specialty medication, common characteristics include complexity, storage, handling and delivery requirements, comprehensive patient management, manufacturer restrictions, and high cost (i.e., >$1000 per member per month [1]) [2,3]
Specialty medications have advanced the treatment of chronic and sometimes life-threatening diseases, including multiple sclerosis (MS), chronic hepatitis C viral (HCV) infection, and hematological/oncological disorders
The purpose of this review is to describe unique transitions in healthcare settings, healthcare providers, among specialty medications, and financial coverage for specialty medications encountered by an integrated health-system specialty pharmacy

Summary

Introduction

While there is no single definition of a specialty medication, common characteristics include complexity, storage, handling and delivery requirements, comprehensive patient management, manufacturer restrictions, and high cost (i.e., >$1000 per member per month [1]) [2,3]. Benefits of these therapies range from improving patients’ quality of life and productivity to prolonging life expectancy or providing a cure. The rapid rise in specialty medication utilization has introduced unique challenges to the healthcare system, most notably managing their high costs, with some costing more than $100,000 per patient per year [5,6,7]. Pharmacy benefit managers (PBMs) reported that specialty medications in the United States comprise 1–2% of prescription claims, but account for 45%

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