The benefits of developing a collaborative, outcomes-based specialty pharmacy program are described.Summary.
With the implementation of risk-based payment models and the rapid growth of specialty pharmacy spend, opportunities exist to establish collaborative and outcomes-focused specialty pharmacy contracts and related programs with regional third-party payers. University of Wisconsin (UW) Health and Unity Health Plans Insurance Corporation have established a contract that sets standards for patient management, pharmacist training and education, electronic medical record documentation, and prescription fulfillment for patients receiving specialty pharmaceuticals. Reporting on metrics of compliance, persistence, and outcomes relative to published benchmarks is required annually. While the contract defines patients by the traditional metric of specialty medication use and includes reimbursement for dispensing activities, it differentiates itself by establishing core services and longitudinal practice expectations for patient care rather than focusing on reimbursement for prescription fulfillment. While it focuses on specialty pharmacy practice, the contract provides an ancillary benefit to all patients using UW Health pharmacies by elevating ambulatory care pharmacy practice standards and improving the patient care process.Conclusion.
The collaborative development of practice standards, service requirements, and patient management protocols offers the rapid elevation of specialty pharmacy services, which provides significant differentiation within the highly competitive specialty pharmacy and third-party payer marketplaces.