Specialty pharmacies provide complex care for patients taking specialty medications. They coordinate medication distribution, education, adherence support, and other services. Steven Linick of Echo Salveo/Optum Specialty Pharmacy discusses the history and role of specialty pharmacies. He explains how they improve outcomes for patients with chronic conditions through personalized programs, counseling, and the use of mobile technologies and telehealth to enhance adherence.

1. SPECIALTY PHARMACY:
AGILE CARE SUPPORT
STEVEN LINICK
REGIONAL BUSINESS MANAGER
ECHO SALVEO/OPTUM SPECIALTY PHARMACY

2. BRIEF INDUSTRY BACKGROUND
1996
Created treatment adherence and persistence programs for NYC based pharmacy that provided services to people
taking complex HIV regimens
1998
Successful results of the program were presented by Columbia University School of Medicine at the World AIDS
Conference in Geneva Switzerland
1998-2000
Created treatment adherence programs used in CVS, Kmart, Pharmor and Pathmark as well a numerous medical
institutions. Programs were sponsored by BMS, Astra Zeneca, Glaxo and Merck.
1996-Present
Helped develop and market specialty pharmacy programs including HIV, HCV, Transplant, Oncology and other
biologics.

3. DEFINITION OF SPECIALTY PHARMACY
• Specialty pharmacies coordinate many aspects of patient care and disease
management.
• They are designed to efficiently deliver medications, provide special
handling, storage, and distribution requirements with standardized
processes that permits economies of scale.
• They are also designed to improve clinical and economic outcomes for
patients with complex, and often chronic and rare conditions, with close
contact and management by clinicians.
Academy of Managed Care Pharmacies Defines “Specialty Pharmacy”:

4. DEFINITION OF SPECIALTY PHARMACY
• Health care professionals employed by specialty pharmacies provide
patient education, help ensure appropriate medication use, promote
adherence, and attempt to avoid unnecessary costs.
• Other support systems coordinate sharing of information among
clinicians treating patients and help patients locate resources to
provide financial assistance with out-of-pocket expenditures.”

5. SERVICES PROVIDED BY PHARMA/MAIL
ORDER/COMMUNITY-BASED SPECIALTY
PHARMACY
Enrollment
• Benefits Investigation
• Co-pay assistance
• Injection Training
• Medication Distribution
Ongoing Support
• Monthly Phone Call Support
• Educational Literature
• Coordination of Benefits
• Treatment Adherence Support

6. • Understand the patient nuances – level of comprehension of medications,
financial issues, consistency of adherence and persistence.
• Understand practice nuances – ability to work with an individual practice in
the most efficient manner.
• Understand nuances of the marketplace – urban vs. suburban vs rural.
• Ability to coordinate services to meet the needs required to actually get the
patient the medications prescribed.
ADVANTAGES OF SPECIALTY
PHARMACIES
ONE SIZE MAY NOT FIT ALL!

7. SPECIALTY PHARMACY PROGRAM
FOCUS:
THE NEEDS OF THE INDIVIDUAL
CONSUMER
1. Personalized education tools (Packaging/Med Action Plan/Mobile
Technology)
2. Payment assistance (Co-pay, Rebate, Coupons, PAN)
3. Individual patient counseling to review medications, side effects, and
answer questions about the medications therapy.
4. Patient group education programs.
Simply Put: Medications Don’t Work if People Don’t Take Them as Prescribed!

8. WE’VE GOT A PROBLEM!

9. SPECIALTY PHARMACIES AND PHARMA NEED
TO WORK TOGETHER TO REDUCE THIS TREND

10. FACTORS FOR NONADHERENCE

11. Specialty pharmacy providers are often able to provide customer-specific programs
to assist consumers with their ability to afford their medications.
Customized Co-Pay Assistance Programs

12. CO-PAY ASSISTANCE PROGRAMS
• Manufacturer’s Co-pay assistance
• Manufacturer’s compassion programs
• Patient Assistance Foundations (ie. PAN, PANF, Cancer Care)

13. SUPPORTING THE PATIENT
• When pharmacists work with patients and physicians to identify patients’ adherence
problems early on, they can address those problems before adverse events occur.
• Specialty pharmacies are well positioned to take advantage of the close pharmacist-
patient relationships they create.
• Bottom Line: For payers, improved adherence means lower spending; for drug
makers, it means more Rx’s filled; and for patients and medical providers, it
means better outcomes.

15. APPS
• The reminder generated by most apps provide an initial SMS reminder
regarding which medications to take and many include a “push notification”
style alert.
• Many apps allow the patient to see which medications they need to take and
even open links to more detailed information and videos concerning their
medications and medical conditions.
• Many “push button” medication reminder apps track the number of doses
taken and missed and may generate reports to track adherence and
persistence.
• Providers may find value in cloud based apps that allow the patients and
providers to export data , including administered and missed doses,
medication databases, regimen changes and addition resources for patient
education.

16. TAILORING REMINDERS
• Adherence apps need to be incorporated into multimodal
strategies to maintain sustained improvements in
adherence and persistence.
• Reminders focus on unintended nonadherence,
understanding reasons for noncompliance and developing
strategies to overcome them is the key.
• In addition to reminders patients may need tailored
messaging, motivational interviewing and periodic
assessment of medication persistence.

17. HEALTHCARE APPS -KEY COMPONENTS
• Medication adherence reminders
• Dose history and adherence reports
• Keep the caregiver team connected
• Timely refill reminders
• Customizable dose and instructions
• Multi-person support
• Doctor and pharmacy tracking
• Drug database
• Custom drug photos

18. EVIDENCE-BASED SUPPORT
• Interactive patient adherence scorecards, including medication adherence rates and
Rx refill reminders.
• Third party notifications if patient has not taken their medications within a pre-
determined period of time.
• Third party notifications if the patient has not reported biometric data within a
specified period of time.
• Care-giver notification if biometric data is out of a safe or target range.
• At-risk alerts for providers identifying patients in jeopardy of non-adherence.
• Patient request to be contacted by a pharmacist for further consultation via text.
• Rx coupons and co-pay programs.

19. EXAMPLES OF TELEHOMECARE DEVICES
• Medication alert watches -vibrating alarm signals patient to take medications.
• Blister packs – Data uploaded reports each time a pill was removed.
• Smart pill containers/pill boxes – Alerts for medication administration time and
transmits notice that cap was removed.
• Mobile technology/Pill phone app- Visual an audible medication dose reminders. Patient
can report medication administration.
• Mobile technology/iPhone/Android apps- Electronic health records and e-
prescribing tools provide mobile access for clinical medication management.

20. TELEHOMECARE SUMMARY
• The simplest function is to provide timing cues regarding the appropriate times to take the medication.
Electronic reporting from microchip devices, such as smart pill containers via the Internet, also known
as telehomecare, is an attractive option and provides objective feedback to the prescriber.
• These electronic interventions have been demonstrated to have significant impact in improving
medication adherence in several chronic diseases.
• Third-party insurers typically do not cover the cost, however various programs and devices may may
be provided by specialty pharmacies.

21. EDUCATIONAL RESOURCES
• Disease management information
• Medication management/drug photos
• Side effect management
• Health/excersize/nutrition tips
• Lab test history/results

22. RESOURCE APPS
• www.medactionplan.com
• www.sharecare.com
• www.mymeds.com
• www.dosecast.com
• www.medsimpleapp.com
• www.medagenda.com
• www.webmd.com
• www.imedicalapps.com

23. • References:
• 1. SXC 2011 Informed Trend Report
• 2. Choudhry NK, Shrank WH, Levin RL et al. Measuring concurrent adherence to multiple related medications. Am J Managed Care.
2009;15:457-464.
• 3. Health Strategies Group, Specialty Pharmacy Management, June 2011.
• 4. EMD Serono Specialty Digest, 8th Edition, 2012.
• 5. Touchette DR, Shapiro NL. Medication compliance, adherence, and persistence: current status of behavioral and educational
interventions to improve outcomes. JMCP. 2008; 14(6): S2-S10.
• Improved Therapeutic Outcomes
• Outcomes of a Specialty Pharmacy Program for Oral Oncology Medications Published Online: August 02, 2012 Suzanne J. Tschida, PharmD,
BCPS; Saad Aslam, PhD; Lincy S. Lal, PhD, PharmD; Tanvir T. Khan, MSc; William H. Shrank, MD, MSHS; Gandhi R. Bhattarai, PhD; Jon C.
Montague-Clouse, BS, MS; Brett D. Sahli, PharmD; and Lee N. Newcomer, MD, MHA

24. CONTACT INFORMATION
STEVEN LINICK
ECHO SALVEO/OPTUM SPECIALTY PHARMACY
(917) 450-3209
EMAIL: SLINICK@ECHOSALVEO.COM