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2014 Armada Presentation - Specialty Pharmacy at Retail Pharmacy


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Rebecca M. Shanahan, CEO of Avella Specialty Pharmacy presents on Specialty Pharmacy at Retail Pharmacy at the 2014 Armada Summit.

Rebecca M. Shanahan, CEO of Avella Specialty Pharmacy presents on Specialty Pharmacy at Retail Pharmacy at the 2014 Armada Summit.

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  • 1. SPECIALTY AT RETAILRebecca M. Shanahan, CEO Avella Specialty Pharmacy
  • 2. Agenda • Specialty Pharmacy Market Drivers • Specialty at Retail Program Highlights • Patient Engagement • Integrated, Real-time Data Sharing • Opportunities for Growth
  • 3. State of Retail Pharmacy • 93% of Americans live within 5 miles of a retail pharmacy • Pharmacists ranked as the second most trusted profession for the third consecutive year (Gallup Poll, 2013) • Pharmacists may soon to be given “provider status’ • Retail pharmacies becoming a healthcare destination (screenings, immunizations, first injections, flu shots, clinic)
  • 4. • 1,256,250 patients per year • Assumes conservative $2,000 per month, 8 scripts per year • Data & Other FFS opportunities • Shared/Aligned Risk Upside
  • 5. Specialty at Retail - Options Traditional SRx Investigate Benefits Hub & Spoke Triage Limited Distribution Drugs Dispensed by XX on Behalf of Retail YY Specialized SRx Lower $$; Higher Volume Drugs Compounds, Infusions & Nutriceuticals Brand Extensions Co-Pay & Discount Cards Persistence & Compliance Payor Centric SRx Disease Specific “Center of Excellence” Geographically Dense Relationships Clinical Program & Data Orphan SRx 3PL Competencies REMS Competencies Roll Out Experience Informatics Competencies Clinical & Program Data IDN/ACO SRx Medical Home Medications @ Discharge 340(b) Programs IPA Relationships Shared Risk
  • 6. The Path of a Specialty Prescription Retail Rx Specialty Rx
  • 7. Location, Location, Location - Patient Access and Empowerment • Patient Assistance Programs • Drug/Disease Education • Persistence & Compliance What Specialty Stakeholders Want Payer Hotbox - Predictable Costs • Value based health care • Bending the cost curve • Documented Comparative Outcomes Actionable Information is the Special Sauce - Quality Clinical Programs • Best Practices Clinical & Formulary Management • Patient & Provider Network Satisfaction Not Your Grandmother’s Soda Fountain – Access to Clinical Pharmacist • Pharmacy & Medical Benefit • Engagement with Patients • Engagement with Physicians & Offices • Real Time visibility to Drug/Disease/Patient Variables
  • 8. Food For Thought • Is Specialty Pharmacy a set of activities that drive patient access & compliance, a “bricks and mortar” profile or both? • Are there discernable factors that drive Pharmaceutical Manufacturers to select certain profiles of Pharmacy Providers? • Hep C, HIV, Infertility, RA have broad Retail dispensing presence • Oral Oncology, Injected and Infused Drugs have more Limited Distribution Specialty Presence • How are site of service changes, e.g. Hospital acquired Medical Oncology Practices, Physician Networks, etc. driving Class of Trade and Pharmacy network differences? • Are there different factors driving Payer Network Selection • National/Affiliated Pharmacies • Fulfillment Pharmacies • Regional Retail &/or SRx Pharmacies • Provider Based Pharmacies
  • 9. Specialty at Retail Program Highlights
  • 10. HIV at Retail Chronic Condition No Limited Distribution Financial Assistance AAHIVM Credentials Adherence Tools Community Focus
  • 11. HIV at Retail • HIV – A Chronic Condition requiring individual regimens, treatment plans and Pharmacist/Patient interactions – 90 to 95 % adherence to HAART achieves Optimal efficacy. – Viral load increases after only 2 days of missed dosing. – Some patients acquire drug-resistant mutations, requiring changes in medication regimen. • Key Compliance Driver – Hands-on Coordinated Care • No increased level of adherence/virologic improvement with intensive telephone counseling as the only approach to adherence (Collier and the ACTG Team, 2002 – HIV patients) • Patient is an active participant in therapy management with MD/RPh professional guidance and regular intervals of review • Adherence is monitored through regular face-to-face interactions with Pharmacists who reach out to Physicians when Patient encounters barriers to adherence Patient Questionnaire Build Meds Schedule Teach Patient • Score Patient Adherence Likelihood • Set Cadence of In person Follow ups • Review of Meds Tracking Measure MPR Review & Report • Collect & Analyze Data • Patient Compliance • Patient Safety • Comparative Outcomes • Share with MDs & RPhD RPh Disease & Drug Education • Standard Content & Scripts • Standard Information & Intervals • One Platform • Sleep pattern • Work schedule • Eating schedule • Travel & weekend schedule • Standardized Meds Adherence Tracking • Build Contingency Plans • Build Pt. Coping Skills • Patient Adherence • Side Effects • Patient Well-Being • Discharge Reasons 90% Compliance
  • 12. Rheumatoid Arthritis at Retail “Specialty Light” Program Patient Education Injection Training Intervention Step Therapy CDAI Scores
  • 13. Outcomes: Patient Counseling and Education
  • 14. Infertility at Retail STAT Medications Disease Management Hub and Spoke Centers of Excellence Trained Pharmacist Provider Relations Compounding Services Passion Patient Education
  • 15. Hepatitis at Retail High Revenue Growth Opportunity Not Limited Distribution Short Duration CDC Testing Guidelines Provider Relations National Testing Day Manage Viral Load Patient Education
  • 16. Patient Access & Empowerment
  • 17. Bi-Directional Text Messaging Program • Text messaging program – Daily reminders to take medication – Reminders for lab work – Educational tips, e.g. blood pressure monitoring – Motivational messaging – Patient surveys • Gather lab values • Pharmacist intervention for any indication of non-compliance – Clinician notified – Weekly emails to clinical staff • Refill Reminders
  • 18. Bi-Directional Text Messaging Program Increase in Refill Rates After Adoption 69.4% 89.4% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Pre-adoption rate 29% Growth in refill rate after adoption of text messaging program Post-adoption rate
  • 19. Study Results The intervention group showed a 12.6% improvement in adherence rate (MPR) over the course of the study.
  • 20. Study Results Intervention group was 78% more likely not to be hospitalized: Saving $27,852 per month in healthcare costs.
  • 21. Integrated, Real-time Data Sharing
  • 22. Integrated Real-time Close-Looped Solutions Will Drive the Future of Healthcare © Copyright 2014, Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health. Shared HIT Solutions Patient Specialty PharmacyPhysician Physician: Increasing complexity of precision therapeutics requires decision support, virtual Clinical Pharmacist Partner Patient: Just-In-Time, 3 minute mobile health solutions to empower the patient & maximize adherence and compliance Specialty Pharmacy: Rapidly expanding arsenal of high-cost, low-volume therapeutics demands personalized approach Ongoing Benefits Management Complexities Patient: Get the right information Get the right drug & dose Get it at the right time
  • 23. Avella Frameworks SRx Integrator Platform The New Specialty Pharmacy: Highly configurable Pushing/Pulling Data Across dispersed yet shared healthcare continuum. Connecting Patients, Payors, Providers, Drug Manufactures, Specialty Pharmacy for better outcomes (Health/Financial) Specialty Pharmacy Management Patient & Payor Physician/Hospital Management
  • 24. Single Repository – User Specific Insights Transactional • Scripts • Authorizations • Fills • Claim Filing • POS/Medical Data Capture • Providers • Pharmacy • Patient • Payor Central Data Repository and Analytics • Contract • Patient Management • Claims Management • Audit Risk Mitigation • Better Outcomes Patients • Better Compliance • Better Management • Lower Cost • Predictable • Better Outcomes
  • 25. Opportunities for Growth
  • 26. SRx Implemented Pathways Programs • 96% cost savings between Payor-sponsored Formulary/Pathways Program vs. oncologists not utilizing pathways for breast, colon and lung cancers (1) • Variance includes only the use of clinically equivalent, evidenced based protocols. Additional savings can be generated from anti-emetics, dose modulation, off-protocol prescribing, management of late stage metastatic disease, and care management (1) Study included practice data for all Medicare HMO patients with a breast, colon, or lung cancer diagnosis at 3 non pathway practices and 1 pathway practice for 12 months. Oncology Spend Comparison Pathway Physician Non-Pathway Physician Avg. Drug Cost Per Person $5,160.6 $10,115.2 Patient Sample Size 15 49 # of Practices 1 3 Avg # of Infusion's Per Month 3.00 3.23 Cost Differential 96%
  • 27. Medications at Discharge CMS Star Rating Re-Admission rates a Key Driver of CSM Star Ratings MPR/Adherence is a Key Driver of CSM Star Ratings Coordinated Discharge and Prescription Follow up Hospital & Pharmacy jointly participate at the Discharge point Patients leave with Rx, and a Follow-up plan from the Pharmacy Numerous Studies Demonstrate poor Rx management at Discharge Poor Patient management of Discharge Rx leads to Re-Admission
  • 28. Movement from Volume to Value Fee for Service
  • 29. Thank You
  • 30. Stay Connected Rebecca M. Shanahan, Esq. CEO of Avella