IU Health Speciality Pharmacy Flashcards
IU Health Speciality Pharmacy
Started in 2014:
- program built around disease states that would have highest clinical impact
- geographically focused
Why:
- in response to demand from clinics and patients
Accreditation:
- first health system in IN to receive URAC accreditation
- payers are more willing to include HC systems that are measured by quality, outcomes, and cost savings
EARLY ADOPTER WHEN COMPARED TO OTHERS
IUH FIRST PARTNERED WITH DIGESTIVE AND LIVER DISORDER HEP C CLINIC
- low volume, high revenue business
- 15 scripts in first month –> 70K revenue
Delivery of Care
SHIFT FROM OUTPATIENT INFUSION TO SELF ADMINISTRATION INJECTABLES
Coverage:
- medical vs pharmacy benefit
Authorization
- pre-certification vs PA
Referral
- order set vs Rx referral to external org
Speciality Pharmacy
- designed to improve clinical and economic outcomes for patients with complex, chronic rare conditions
- coordinate sharing of information among clinicians treating patients through EMR
- provide patient education and help ensure appropriate medication use
- promote adherence, and attempt to avoid unnecessary costs
- help patients locate resources to provide financial assistance with OOP
- efficiently deliver medications with special handling, storage, and distributor requirements with standardized processes that permit economies
- actions not branding/intentions are required to truly operate as speciality pharmacy
Process of Delivery of Speciality Pharmacy to Patient at IU Health
Affiliated IU Health MD writes Rx –> Sent to IU Health Pharmacies –> transfer to competitor speciality pharmacy if needed
Why ship to competitor speciality pharmacy?
Drug Lockout: speciality medications IU Health is unable to fill due to manufacturer restrictions
Payer Lockout: speciality medications IU Health is unable to fill due to payer contracts
Incremental Open Access: speciality medications that could be filled by IU Health if prescription received
Challenges Presented by External Speciality Pharmacy
- transitions of care
- fragmentation of care
- undefined roles and poor accountability
- lack of transparency
Advantages of IU Health Speciality Pharmacy
- highly trained pharmacists are dedicated to each disease state
- team ensures that every treatment plan is the best care
- execution of care plan is easier for providers and staff since they all work in same medical record
CLINICAL PHARMACY EXPERTISE
TRANSPARENCY OF EMR
IMPROVE COMMUNICATION OF PROVIDERS
Barriers of IU Health Speciality Pharmacy
- services and footprint is limited along with staffing recruitment challenges
- coordinate efforts around medical contracting to include speciality pharmacy as in-network
- lack of consumer facing service enhancements compared to external
- access to limited distribution drugs
- changes in 340 B site eligibility
Do providers prefer internal or external speciality pharmacy?
providers preferred INTERNAL in every category
Roles of Technicians
- benefit investigations
- initiate new and renewal PA
- follow up calls
- patient assistance
- refill management
Role of Pharmacists
- clinical onboarding of new referrals
- review and submit PA
- provide drug education and injection training
- clinical follow-ups with patients annually
- clinical interventions
IU Health Referral Process
Referral in Pool (Rx sent to ATP) –> PA approved & affordable –> triage to in-network pharmacy + education and shipment –> monthly refills and 6 month follow-up
Referral in Pool (Rx sent to ATP) –> PA denied or unaffordable –> appeals –> patient assistance
Therigy
- task driven workflow
- assessments
- initial
- follow up
- refill calls
- URAC requirements
set filters & search for tasks
Interventions at IU Health
308 interventions completed in Q4
Interventions:
1. sub optimal drug
2. medication monitoring
Medications:
1. Humira
Diseases:
1. Rheumatoid Arthritis
2. HIV
3. IBD
Largest reason for IU Health sending things externally
pharmacy not in network
