Specialty drug expenditures in the U.S. are rising dramatically, compelling manufacturers to accelerate the turnaround time from patient enrollment to drug disbursement. Using data analytics tools, these companies can track patients throughout their treatment and ensure continuous patient therapy.

1. Identifying & Overcoming Gaps in
the Specialty-Pharmacy Ecosystem
By effectively monitoring specialty pharmacies at different stages
of drug approval and understanding the challenges patients face,
manufacturers can accelerate the delivery of these complex
medications.
Executive Summary
U.S. specialty pharmacies are becoming big
business. In 2014, consumers increased their
spending on specialty medications by an
unprecedented 31% from 2013.1
Moreover, three
specialty classes – inflammatory conditions,
multiple sclerosis and cancer – accounted for
60%2
of total specialty spending in 2013. This
upsurge is due in part to U.S. healthcare reform,
which generated new models for delivering and
paying for care, and underscored the pivotal role
that specialty pharmacies now play.
In this climate, specifications for handling,
delivering, storing, preparing and distribut-
ing specialty drugs prior to administration can
challenge manufacturers, who must become
adept at identifying and overcoming gaps in their
existing care-delivery model. If not addressed,
shortcomings in areas like administration, training
at the sales and pharmacy levels, and drug
utilization management can significantly affect a
company’s operations.
Moreover, the many channels involved in specialty
drug disbursement underscore the need for
organized, systematic improvements in how this
process is managed.
cognizant 20-20 insights | may 2016
• Cognizant 20-20 Insights
Considering these issues, as well as the
pharmaceuticals industry’s dynamic landscape,
it is imperative for players large and small
to ensure they achieve the highest levels of
efficiency throughout the stages of delivering
complex care. Doing so will serve the two-
pronged objectives of today’s pharmaceuticals
companies:
• To provide patients with critical life-saving
drugs as seamlessly and cost-effectively as
possible.
• To improve the company’s bottom line by
enhancing operational efficiencies.
This white paper examines the typical stages of a
patient’s journey across the specialty pharmacy
system, the points that can stall the delivery
of essential medication, and the crucial role
played by managed market players. We also
outline a range of descriptive analytics that can
help identify and reduce major bottlenecks, as
well as potential solutions for addressing these
challenges.
Defining a Specialty Pharmacy
A specialty pharmacy provides critical health
services, with an emphasis on high-priced

2. cognizant 20-20 insights 2
medication therapies that require close
pharmacist/patient relationships and involve
numerous customers within various therapy
areas. The diseases covered by specialty
pharmacies range from critical illness such as
cancer, to rare genetic conditions. Specialty
pharmaceuticals can be injected, infused,
administered orally or inhaled.
Specialty pharmacists practice in a variety of
environments that focus on specialty medica-
tions. Specialty pharmacies support patients in a
number of areas: dispensing medication, admin-
istering medication therapy, patient advocacy,
and treatment compliance, among others.
Pharmacists who work in more traditional retail
settings concentrate on certain specialty disease
states at their practice sites, or work with an
affiliated specialty pharmacy to dispense these
complex treatments.
Though often challenging to stock, manage and
monitor, specialty pharmaceuticals are at the
forefront of cutting-edge medical care. They
can be effective in treating formerly incurable
diseases and reducing the pain and suffering
associated with certain chronic illnesses.
The Increase in Specialty
Pharmaceuticals
There is ample evidence that specialty pharma-
ceuticals are big business:
• Specialty drug expenditures comprised 31.8%
of the overall U.S. drug spend in 2014, up
from 27% in 2013.3
Since 1990, the number
of specialty pharmaceuticals approved by the
FDA has doubled approximately every five
years, with almost 200 drugs currently in use
and more than 1000 in development.
• Specialty pharmaceuticals expenditures in
the U.S. approached $100 billion in 2010, and
are expected to increase at a rate of 12% to
15% annually.
• While only representing 1% of all U.S. prescrip-
tions in 2013, specialty drugs accounted for
more than one quarter (27.7 %) of the nation’s
total pharmacy spend.4
>> New breakthrough products expected
over the next few years include drugs for
hepatitis C, multiple sclerosis, cystic fibrosis
and a number of cancers.
>> New pharmacy models and data require-
ments are beginning to emerge from the
macro changes occurring in the healthcare
arena.
• Healthcare reform has accelerated efforts to
create new care-delivery and payment models.
Together, these trends are forcing manufacturers
to rethink and readjust how they interact with the
healthcare system – a shift that will create major
opportunities as well as significant challenges.
Recent Trends in the Specialty
Pharmaceuticals Industry
According to Drug Trend, while pharmaceuticals
manufacturers continue to bring new ground-
breaking products to market, their efforts are
being undermined by the prices charged to
cash-strapped managed market payers and
patients.5
Hence, manufacturers and specialty
pharmacies typically forge agreements to make
these drugs more affordable to payers and
more accessible to patients.
The overall amount of money spent on pharma-
ceuticals increased in 2014 by 13.1%6
following
several years of decline – a situation that was
due in part to the high cost of drugs. During
the period between 2013-2014, there was a
small decline (0.1%)7
in traditional prescription
medication expenditures, despite a 6.5%8
hike
in costs. However, the use of specialty-pharmacy
medications rose by 5.8%9
in spite of a +25.210
increase in cost (see Figure 1, next page).
Between 2013-2014, there was a 30.9%11
jump in
spending for specialty medications – the highest
specialty drug trend ever recorded.
Given that specialty pharmacies contribute
to major drug spending, accelerating the
turnaround time from patient enrollment to
eventual drug disbursement will not only help
patients, but significantly improve the bottom
line for the manufacturers of these drugs.
Tracking Patients on Their Journey
Specialty pharmacies play a vital role
throughout a patient’s therapeutic journey –
from the time a drug is initiated, to the hand-
holding required through the various stages
of the insurance process, to ensuring that
Specialty pharmaceuticals, which are
used to treat high-cost, chronic and/
or life-threatening diseases, can be
injected, infused, administered orally
or inhaled.

3. cognizant 20-20 insights 3
Quick Take
the patient receives the drug. Consequently,
making this process more efficient will revolve
to a large extent around making changes to a
pharmacy’s internal and external processes.
First, it is essential to understand the typical
stages patients go through before they receive
specialty medications (see Figure 2, next page).
• Stage 1: Physician office. A patient first visits
a specialist, who recommends a specialty drug
to treat the patient’s condition. The specialty
pharmacy receives the order from the doctor
via fax, phone or electronically through the
pharmacy’s physician network. A treatment
form, created by the drug’s manufacturer,
is forwarded by the pharmacy to both the
patient and the physician, along with the
recommended dose of free (or starter) drugs,
to be delivered to the patient ideally by day
four. The service center at the specialty
pharmacy works with the patient to
coordinate how the patient would like to
receive information on the benefits of the drug
and have their questions answered regarding
efficacy and dosage, for example. At this
stage, the patient must inform the pharmacy
if they will require financial assistance, or if
their current medical coverage is sufficient.
Following the completion of the necessary
forms, the pharmacy ships a starter pack
to the patient’s residence.
• Stage 2: Co-pay assistance. Patients who
require financial aid are routed to financial-
assistance organizations, such as CVC or
NORD; patients who procure a drug through
their commercial medical plans are aided
according to their requirements. This stage can
take a significant amount of time for patients,
given the need to further review their records
and their justification for qualifying — a process
that can involve investigating benefits and
assessing prior authorization, for example.
• Stage 3: Specialty distribution of paid Rx.
Following benefit assistance and fulfillment,
the paid Rx is dispensed by the patient’s
specialty pharmacy and delivered to their
home. Ongoing nursing support, as well
as follow-ups, are provided through the
specialty pharmacy service center via e-mail
or phone. The pharmaceuticals manufacturer
then contracts with the specialty pharmacy
to regularly track the patient’s adherence,
report any adverse events, and address
specific concerns the patient may have.
Focusing on Fulfillment Analysis
Patients who require specialty treatments can
only start on a drug through the contracted
specialty pharmacy, which has the ability to
monitor a patient at all stages – from initiation
to product fulfillment. The resulting data can be
used to examine and understand each phase of
the patient’s treatment.
The aim is to identify major bottlenecks, and see
to it that the specialty pharmacy’s management
team works with the drug manufacturer to ensure
that the time it takes for a patient to complete the
treatment cycle is significantly improved.
A comprehensive data analysis can be conducted
to track a patient’s progress as they make their
way through the specialty pharmacy system
(see Figure 3, page 5).
U.S. Drug Trend: Overall, Traditional & Specialty
Figure 1
-4%
0%
4%
8%
12%
16%
20%
24%
28%
32%
2006 2007 2008 2009 2010 2011 2012 2013 2014
%DrugSpend
Overall Drug Trend Traditional Drug Trend Specialty Drug Trend

4. cognizant 20-20 insights 4
There are specific points where the drug dis-
bursement process can stall. In-depth analytics,
which feed into the data-collection contracts
that pharmaceutical companies have with
specialty pharmacies, can provide deeper insight
into these issues.
Once the patient is triaged to the dispensing
specialty pharmacy and starts receiving a paid
prescription, they finally convert to “active
status.” In some cases, patients discontinue the
drug, based on their prescriber’s recommenda-
tion, their own choice, or due to insurance issues.
A patient’s receipt of specialty drugs can be
delayed for numerous reasons. Thus, it is
important to identify the exact points (outlined
in longitudinal studies) where problems exist,
and focus on areas that require improvement:
• New patients typically encounter problems
during the enrollment stage. These roadblocks
can be due to benefits investigation (BI)
processing, an incomplete patient treatment
form, or pending foundation approval. By
this time, a majority of patients should have
received a free drug to initiate therapy.
• A patient can opt out of the program for
numerous reasons, such as an adverse event
(side effect), lack of efficacy or treatment
with alternative medications.
• A patient has to wait longer for their
prescription to be shipped due to insurance
investigations. We call this “pending status.”
At this point, the patient could be sent back
to the enrollment phase if their paperwork is
not in order, or if they encounter other issues,
such as an out-of-network prescriber.
A Typical Fulfillment Process
Figure 2
HUB - Rx Intake, Benefits,
Investigation & PA Assist1
Physician Office
Patient Home
Copay
Assistance2 Specialty
Dist. of Paid Rx3
Patient Home
Patient Home
HUB HUB Specialty
PharmacyFoundation
Treatment form
(incl. starter Rx)
sent to support
center (SC).
SC communicates
benefits to patient.
Inquires if patient
is in need of
assistance.
Welcome to
BRAND A
from SC Nurse
Ongoing
nurse follow-ups
Starter Rx (free)
is delivered to
patient within
four days.
Std. (Paid) Rx
sent monthly by SP.
The aim is to identify major
bottlenecks, and see to it
that the specialty pharmacy’s
management team works with the
drug manufacturer to ensure that
the time it takes for a patient to
complete the treatment cycle is
significantly improved.

5. cognizant 20-20 insights 5
Affording Actionable Insights
Pharmaceuticals companies’ marketing teams
can benefit greatly by assessing the gap
between the number of days from when a patient
enrolls for a specialty drug to when their regular
supply is delivered.
Some of the potential challenges pharmaceuti-
cals companies face when dealing with specialty
drugs are highlighted in Figure 4 (see next page),
along with actions that can help mitigate them.
Looking Forward: Next Steps
Scientific advances and innovations in specialty-
pharmacy products will accelerate in the coming
years – adding to the arsenal of beneficial cures
and treatments. Ensuring that patients receive
the right drug in the most appropriate setting
will depend on improving the drug distribution
process.
Employing descriptive analytics to track
patients throughout the specialty pharmacy
disbursement process can help identify and
diagnose pain points in drug distribution and
ensure continuous, seamless patient therapy.
Effectively analyzing the patient flow at different
stages of a patient’s drug treatment allows
manufacturers’ marketing teams to increase
the effectiveness of marketing programs across
physician, patient and pharmacy channels,
enhance the company’s brand and boost sales.
This is critical, given the expected year-over-
year cost increases in specialty pharmaceuticals.
Finally, data analytics enables specialty drug
manufacturers to:
• Track patient adherence and reasons for
cancellations.
• Improve the processes and management
associated with contract pharmacies.
From Treatment Initiation Through Drug Dispensation: A Patient's Journey
HUB in Progress
Foundation
Enrollment in
Foundation
Enrollment in
Non-Foundation
Specialty Pharmacy
Treatment Initiation Form
Received at HUB
Triaged to
Specialty Pharmacy
Cancelled/
Discontinued
Enrollment/
Pending
Active
Triaged to
Specialty Pharmacy
Cancelled/
Discontinued
Enrollment/
Pending
Active
N
N
N NN
N
N
N
N N N N
N
Currently Pending
Foundation
Approval
Currently
Enrolled
Currently
Enrolled
# of Days – Total Enrollment
to Active / Paid Drug
First Enrollment as ActiveFirst Enrollment as Active
Moved to
Cancelled
Moved to
Pending
Apply for Payment Assistance
N = Avg. # of Days
Enrollment to Triage to SP
(not via foundation)
Cancelled/
Discontinued
ActivePendingEnrollment
Cancelled/
Discontinued
ActivePendingEnrollment
N N
N
N
NNN
Figure 3
Pharmaceuticals companies’ marketing
teams can benefit greatly by assessing
the gap between the number of days
from when a patient enrolls for a
specialty drug to when their regular
supply is delivered.

6. cognizant 20-20 insights 6
• Employ descriptive analytics to enable
positive organizational and process changes.
Using these tools, pharmaceutical teams
can address and understand the intrica-
cies of the rapidly evolving specialty-
pharmacy landscape, and rest assured that
the processes surrounding specialty treatments
are efficient, secure and patient-centered.
Figure 4
Challenges Actions
Challenges Actions
Challenges Actions
High patient cancellation rate.
Low HCP titration rate.
Specialty pharmacies (SPs) unable to
contact HCP for second Rx.
Monitor reason codes for cancellation.
Introduce nurse support programs to
guide patients and caregivers.
Patients can be managed by specialty
pharmacy service centers until
maintenance dose is reached.
SPs can explore new ways to contact HCPs
(text, e-mail, web portal, hot lists).
Product
Fulfillment
Changing Foundation Rules - FPL (Federal
Poverty Level), types of coverage.
Foundation organizations not efficiently
structured.
Higher % of prior authorizations.
Less disabled patient population with
income levels above FPL.
Move patients to foundations that accept
lower FPL levels.
Improve patient processing systems at the
foundation level.
Increase SP service center staff.
Financial
Assistance
Increase in % of filled treatment forms.
Timing of patient visits.
Higher % of prior authorizations.
Specialty pharmacy system is new for
some types of HCPs.
Roll out simplified online versions of
treatment forms.
Provide communication/education for
sales reps re: benefits of the SP process.
Set up a task force to evaluate numerous
options for making prescribing easier.
Create new treatment form.
Treatment
Initiation
Specialty Pharma’s Special Challenges

7. cognizant 20-20 insights 77cognizant 20-20 insights
Quick Take
Business Situation/Challenge
• A leading manufacturer of a specialty treatment
for neurological disorders required a deeper
understanding of the patient journey – from
enrollment to the time a drug was dispensed.
The Solution
• We conducted a comprehensive data analysis –
tracking the entire treatment history for every
patient to whom the drug was dispensed.
• The average time it took patients at each point in
their treatment/pharmacy cycle was calculated
based on historical data.
• A longitudinal study confirmed the areas
where the provider needed to work closer with
specialty pharmacies to shorten and improve
the process.
The Benefits
• The analysis uncovered major areas for process
improvements, including product fulfillment,
financial assistance programs and treatment
initiation.
• The analysis helped the manufacturer make
more informed decisions by focusing on specific
roadblocks – reducing pharmacy-related per-
formance issues that caused delays in drug
delivery.
• Our findings also provided valuable insights
to enable the company’s specialty pharmacy
management team to better coordinate with
pharmacies, and ensure significant improve-
ments in patients’ treatment journeys.
Performing a Patient Flow Analysis

8. cognizant 20-20 insights 8
References
• http://www.pharmacist.com/specialty-pharmacy
• http://drugchannelsinstitute.com/files/2014-15-PharmacyIndustry-Overview.pdf
• http://www.pm360online.com/why-specialty-pharmacy-management-cant-be-ignored/
• http://lab.express-scripts.com/~/media/PDFs/Drug Trend Report/ExpressScripts_DrugTrendReport.ashx
• Specialty Pharmaceuticals - SCIO Health Analytics PDF (www.sciohealthanalytics.com)
Footnotes
1
2014 Drug Trend Report, Express Scripts, March, 2015.
http://lab.express-scripts.com/~/media/PDFs/Drug Trend Report/ExpressScripts_DrugTrendReport.ashx
2
Ibid.
3
Ibid.
4
2013 Drug Trend Report Highlights, The Express Scripts Lab, April 8, 2014. http://lab.express-scripts.
com/~/media/pdfs/drug%20trend%20report/express%20scripts%202013%20drug%20trend%20
report%20highlights%20online.ashx.
5
2014 Drug Trend Report, Express Scripts, March, 2015. http://lab.express-scripts.com/~/media/PDFs/
Drug Trend Report/ExpressScripts_DrugTrendReport.ashx.
6
Ibid.
7
Ibid.
8
Ibid.
9
Ibid.
10
Ibid.
11
Ibid.

9. About Cognizant
Cognizant (NASDAQ: CTSH) is a leading provider of information technology, consulting, and business
process outsourcing services, dedicated to helping the world’s leading companies build stronger
businesses. Headquartered in Teaneck, New Jersey (U.S.), Cognizant combines a passion for client
satisfaction, technology innovation, deep industry and business process expertise, and a global,
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centers worldwide and approximately 233,000 employees as of March 31, 2016, Cognizant is a member
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About the Authors
Prerna Chakravarty is a Manager within the Cognizant Analytics Practice. She has more than
seven years of experience focusing on marketing analytics for the pharmaceuticals industry.
Prerna has worked on a wide range of analytics projects, including promotion response and
sales force and marketing campaign effectiveness. Over the past several years, she has focused on
analytics around specialty pharmacy data for niche neurology drugs. She can be reached at
Prerna.chakravarty@cognizant.com.
Amit Kumar Noteka is a Senior Associate within the Cognizant Analytics Practice. He has more
than five years of experience in the analytics space working in various domains such as retail,
telecom and life science – performing complex analytical requests, campaign management and
working with BI tools. He can be reached at Amit.Noteka@cognizant.com.
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