Q&A: How Health System Specialty Pharmacies Improve Costs and Care

When it comes to reducing care costs and ensuring medication access, health system specialty pharmacies have a role to play, according to Bill McElnea, vice president of population health at Sheilds Health Solutions. McElnea sat down with Drug Topics at AXS24, the Asembia Specialty Pharmacy Summit, held April 28 to May 3 in Las Vegas, Nevada.

Drug Topics: How do health system specialty pharmacies reduce care costs for patients?

Bill McElnea: Primarily through medication adherence. We really see quite the horizontal impact of good medication adherence across a range of different disease states, whether it’s annualized relapse rates in multiple sclerosis or sustained virologic response in hepatitis C. That really is the starting point for a whole lot. If a patient's adherent to their meds, [they’re] going to have a lot less complications. If they have a lot less complications, they're not going to have to go to the hospital as much, and they're not going to see their physician as much, and that has a real bearing on costs, for sure.

I think there is, separately, a lot of increasingly non-pharmacy types of services—[or maybe non-traditional services]— that you're seeing. [You’re seeing] pharmacists give more and more nutrition and lifestyle counseling [which] is really impactful and important to so many different disease states. Another exciting thing we're seeing is clinical pharmacists provide support on social determinants of health, both screening and referring our patients to local community organizations for any services that they themselves can't provide.

Drug Topics: Can you share some examples of how the movement of health system specialty pharmacies into other clinical spaces like diabetes, COPD, have improved?

McElnea: Something that’s been great is that [when] we were starting in on this space, we weren't exactly sure how the model was going to translate into these non-traditional spaces, but it is translated very well. Across our network, we regularly see medication adherence rates and their diabetes programs in excess of 90% [proportion of days covered], average copay is about $10—which is a real game-changer for clinics as well. They have to field a lot of concerns and questions about affordability a lot of times for patients. So, when you're introducing them to this model, and all of a sudden they have a pharmacy liaison that's really looking out for them, it really makes a world of difference.

Because of that impact—better affordability, better adherence—we have seen average [hemoglobin A1c (HbA1c)] rates typically will come down by a full point just on average across a population. We've even seen for more at-risk populations where we've dedicated [ambulatory] care pharmacist resources [HbA1c] decreases of 2 points or higher and sustained there over a year time. So, a lot of great things [are] coming out of [the] holistic [health system specialty pharmacy] model being deployed in these areas.

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