Specialty Pharmacy: Build, Buy, or Partner

Dan Duffy
Published: Wednesday, Feb 22, 2017
Dan Duffy

Dan Duffy

The use of oral oncolytics is rapidly expanding, giving patients promising new treatment options. In 2015, nine oral cancer drugs were approved by the FDA, and of the 836 cancer medicines and vaccines biopharmaceutical companies currently have in clinical development, 25% are oral agents.

Every oncology practice operates with the same mission: to provide the best patient care possible. Yet, that care is not delivered in a vacuum. Today, oncology practices are faced with reform initiatives and market challenges that create gaps in their ability to manage patient care, ensure patient access to medication, and succeed in a value-based care environment. Consequently, oncology practices often turn to specialty pharmacies to gain access to vital oncolytics and for help in filling these gaps. Oncologists need a pharmacy provider with extensive therapeutic expertise and experience in oncology that will support their treatment plans and alleviate their administrative burden so that they can focus on treating patients. They want a pharmacy provider with the skill, expertise, and resources to understand and help manage the clinical, financial, and emotional complexities associated with cancer treatment.

For oncology practices that want to expand specialty pharmacy services on behalf of their patients, should they build, buy, or partner?

Buy: this offers many of the same benefits of building your capabilities and may accelerate the process and limit diversion of focus; however, it requires significant upfront capital.

Build: this requires a significant investment of time and resources, but allows practices to maintain control. Questions to consider: do you have the expertise to build from scratch? Will this divert attention from higher priorities?

Partner: practices enter a symbiotic relationship based on aligned goals. Partnerships are generally a faster way to add services and capabilities and require fewer upfront resources; however, they involve compromise, with both partners relinquishing some control.
For health system-based oncology practices or large national oncology practice networks, build and buy are viable options; whereas, for most community practices, partnerships may offer the fastest, most cost-effective method to expand their specialty pharmacy capabilities and create value for their patients.

Specialty Pharmacy Partnerships Are Not all Alike

Specialty pharmacy partnerships can take a number of forms, such as working with an independent specialty pharmacy in the same community or a regional pharmacy provider that specializes in therapeutic classes that match the practice’s patient mix. Oncology practices can also look to small technology or consulting companies that can help address specific functions, such as prior authorization, medication reconciliation, or patient support and education.

Another option is to work with a full service provider that not only provides access to drugs but also strives to become a valued member of the provider’s care team. Such a full-service provider may have similar patient outcome goals, deep therapeutic expertise in cancer care, and a wealth of patient-centric services to drive better outcomes.

Regardless of which form your specialty pharmacy partnership takes, the ultimate goal should be to protect the long-term viability of your oncology practice by helping it to become more efficient and more profitable.

Patient Access and Practice Management Support

One of the primary reasons oncology practices first turn to specialty pharmacies is to gain access to the lifesaving drugs that are vital for their patients. Drug manufacturers often restrict distribution to specific channels, blocking access for the practice’s in-office dispensing pharmacy. Even if the drug can be obtained by the practice, getting payment can be difficult, as payer-approved pharmacy networks are often very restrictive.

There are also financial barriers associated with oral cancer medications that can create both access and adherence issues. According to Biologics research, nearly 20% of new patients participate in manufacturer payment support programs or receive financial assistance for their medications. Many patients, especially those in late-stage therapy, have already had a difficult journey, both physically and financially. It’s very beneficial to have a pharmacy provider that stays current with manufacturer or nonprofit patient-assistance programs, changing regulations, and enrollment processes and can help patients to solve financial issues.

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Community Practice Connections™: Addressing Post-Transplant Obstacles: Current and Emerging Strategies to Evolve the Standard of Care for Patients With Graft-Versus-Host DiseaseMar 28, 20192.0
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