SPECIALTY PHARMACY: AGILE CARE SUPPORT

STEVEN LINICKREGIONAL BUSINESS MANAGER

ECHO SALVEO/OPTUM SPECIALTY PHARMACY

BRIEF INDUSTRY BACKGROUND1996 Created treatment adherence and persistence programs for NYC based pharmacy that provided services to people taking complex HIV regimens1998Successful results of the program were presented by Columbia University School of Medicine at the World AIDS Conference in Geneva Switzerland1998-2000Created 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-PresentHelped develop and market specialty pharmacy programs including HIV, HCV, Transplant, Oncology and other biologics.

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”:

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.”

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

• 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!

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!

WE’VE GOT A PROBLEM!

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

FACTORS FOR NONADHERENCE

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

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

Care)

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.

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.

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.

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

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.

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.

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. 

EDUCATIONAL RESOURCES

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

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

• 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

CONTACT INFORMATION

STEVEN LINICKECHO SALVEO/OPTUM SPECIALTY PHARMACY

(917) 450-3209EMAIL: SLINICK@ECHOSALVEO.COM