Specialty Pharmacy - Episode 1

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Transcript

00;00;00;00 - 00;00;26;17
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You are listening to “ Vital Signs: A Podcast for Sentara Providers”. Welcome to episode one of Specialty Pharmacy Series. Before we turn things over to the specialty pharmacy team, let's go over some important CME announcements. This episode has been accredited for AMA PRA Category one credits for detailed accreditation and designation information along with disclosure information. Please visit the show notes.

00;00;26;20 - 00;00;41;08
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This information can also be found on our website www.sentara.com/physicianeducation as well as always reaching us by email at physicianeducation@sentara.com. Here is Ashley Hamel. 

00;00;43;15 - 00;00;58;09
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We are really excited you joined us to learn more about Sentara Specialty pharmacy's Sentara case management pharmacy, and Proprium. Utilizing these pharmacies can help provide continuity of care for our patients.

00;00;58;11 - 00;01;30;23
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Our objectives for today's podcast are to provide an overview of what specialty pharmacy is. Provide a background in history of one of our Specialty Pharmacies Proprium and understand the clinical and financial outcomes obtained from care provided from specialty pharmacy. Our first session we will have Jim Schwamberger, director of Program Pharmacy, and Jeremy Spiers, the operations manager at Program Pharmacy, joining us today.

00;01;30;26 - 00;02;00;11
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What is specialty pharmacy? Good question. Specialty pharmacy serves patient populations with rare and complex conditions such as autoimmune diseases, infectious diseases, oncology and transplant patients. Specialty drugs account for a growing portion of the drug pipeline and are typically very high cost, often exceeding $5,000 per month. They often have challenging delivery and storage conditions as well. Specialty medications require special handling and temperature control.

00;02;00;18 - 00;02;29;10
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Typically, they're difficult to access and distributed through limited distribution channels. Specialty patients face many transitions in care and require comprehensive patient support and education to ensure they remain adherent to the drug regimen, as well as administrative support for prior authorizations. Benefits verification and financial assistance. Specialty drugs are the fastest growing and largest component of the pharmaceutical market, and as of 2020, accounted for 53% of all drug spend.

00;02;29;13 - 00;02;58;03
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Specialty drugs continue to drive growth in the U.S. and will make up nearly 60% of total drug spending by 2025. Payer C Specialty drugs as a high percent of their costs and PBMs have acquired specialty pharmacies to capture dispensing revenue and increase control of specialty networks. So how is specialty pharmacy different from my local retail pharmacy? There are a few ways that specialty pharmacy is different than a typical retail pharmacy.

00;02;58;05 - 00;03;34;07
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First specialty pharmacies, since they have such complex disease states and drugs must go through an accreditation process. Most specialty pharmacies have at least one accreditation. Some even are dual accredited through ACHC and URAC. Additionally, pharmacists often undergo extra training and support in order to be able to help these patients take care of these complex disease states. Furthermore, since the cost of the medications is so much higher, there is a lot of effort done to make patients able to afford their medication through various financial assistance programs and prior authorizations.

00;03;34;10 - 00;04;02;11
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Where did specialty pharmacy come from? Specialty pharmacy has been around for decades, yet seemed to really become defined as an area of pharmacy practice. In the early 2000s due to the advancement and development of medications that are used to treat rather complex conditions. Some of these conditions include autoimmune disorders, oncology, cystic fibrosis, amongst others. Why can't patients fill in any and all their medications at a local pharmacy?

00;04;02;13 - 00;04;27;24
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As we explained earlier, there are certain medications that are only approved to be dispensed at approved specialty pharmacies that are granted approval by the manufacturer. Oftentimes, these are referred to as limited distribution drugs. Also, insurance companies may determine which pharmacy or type of pharmacy can dispense certain medications for their pharmacy insurance plans. This is often due to the costs associated with these medications and also the complexity of them.

00;04;27;26 - 00;04;59;15
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Many times, requirements for additional monitoring or support by the pharmacy team achieved in a specialty pharmacy environment cannot be offered at a retail pharmacy location and therefore limits the availability to dispense outside of a specialty pharmacy. Examples may include additional lab value monitoring, adherence management or adverse events, mitigation strategies. What advantages are provided in a specialty pharmacy that may not be found in a local retail pharmacy? Similar to what was stated earlier --

00;04;59;17 - 00;05;27;21
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the level of expertise with the clinical pharmacists and support staff for the dispensing of these very unique therapies or complex patients are not the same in the retail setting. Adherence management, financial assistance support and prior authorization support to help improve the patient journey is also a focus at both of Sentara’s two Specialty Pharmacies. Proprium Pharmacy is our specialty pharmacy that services our commercial patients as well as Medicare patients.

00;05;27;23 - 00;06;00;10
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Case management, pharmacy services. All of central health plans manage Medicaid patients. We appreciate the overview of specialty pharmacy. Next, we'll move on to the background and history of Proprium Pharmacy. We are joined by one of Prorium pharmacist Janelle Donna, for daring to give me some background history of appropriate pharmacy. So Proprium Pharmacy was founded in 2016 and the word “proprium” was chosen because it is Latin for a specialty.

00;06;00;12 - 00;06;27;11
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It's Sentara Specialty Pharmacy, which is located in Chesapeake. The mission of Proprium is to make the prescription filling process as simple as possible so that patients can focus on what really matters improving their health. They are dedicated to meeting patients specialty pharmacy needs and are committed to excellent customer service. The team consists of highly skilled pharmacist pharmacy technicians and patient care advocates who are friendly and eager to help.

00;06;27;13 - 00;07;02;15
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Program services include personalized, personalized care for every patient. A live answer by a team member when a patient calls. Education by specially trained pharmacist, support with insurance, processing enrollment and financial assistance programs, friendly refill reminder calls, and convenient and free medication delivery. Next, we are joined by Amy Riggs, team coordinator at Proprium Pharmacy. Amy will be outlining the clinical and financial outcomes for patients who receive their prescriptions from Proprium Pharmacy.

00;07;02;17 - 00;07;08;12
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We'll learn a little bit about why program stands out from the crowd and the benefits seen to our patients.

00;07;08;12 - 00;07;30;23
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What differentiates program from other specialty pharmacies? Proprium Pharmacists and support staff have advanced training across the many disease states and medications that are dispensed to ensure safe and appropriate care is provided for each patient throughout their journey, regardless of duration of treatment. Proprium is, as I mentioned before, is truly accredited by two different accreditation bodies.

00;07;30;23 - 00;08;00;08
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That requires a high standard of care to be met by the pharmacy to maintain accreditation Proprium staff allows for individualized care for each patient across disease states supported to ensure that care management strategy as supports that patient which will likely be different than others across similar disease states or medications. Examples include adjusting the frequency of touch points by the pharmacists and a refill a management team, along with the collaboration between the pharmacy and clinic staff.

00;08;00;08 - 00;08;24;27
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What is one part of accreditation that you feel separates Proprium Pharmacy from other specialty pharmacies? To maintain accreditation, Proprium must work with an outside survey company to assess the pharmacy program with providers and patients. These are anonymous managers outside of Sentara and program and results provide shows scores at 79 when serving providers and 88 with patients being supported by Proprium.

00;08;24;29 - 00;09;02;29
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Anything scored above 70 is defined as world class care, and it's not unheard of to see scores with specialty pharmacies below 50 due to the complexity of managing these patients that create challenges for patients and providers. How do clinical pharmacists appropriate manage these patients and even help the providers in managing these patients? The clinical pharmacist, appropriately will review the patient's chart, provide initial counseling and a touch base with each patient multiple times throughout therapy being dispensed. As pharmacists identify issues such as drug interactions, duplicate therapies, omission of therapies --

00;09;03;01 - 00;09;14;04
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they will engage with the provider and recommend suggestions for the provider team to consider. Depending on the response these will be documented and logged as clinical interventions to ensure medications are safe and appropriate.

00;09;14;04 - 00;09;26;07
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So why did the Proprium pharmacist document these clinical interventions and what are advantages of doing so? Documenting is important to continue to monitor the work performed daily by our pharmacists.

00;09;26;10 - 00;09;47;08
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Each type of clinical intervention that may be logged by a pharmacist has an associated monetary value associated with action that was determined through many pharmaco economics studies published in the literature. Just in 2023 alone Proprium pharmacists and documented clinical interventions that total more than $2 million in health care cost avoidance.

00;09;47;08 - 00;09;51;16
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What are some other advantages that can be seen working with appropriate pharmacy?

00;09;51;19 - 00;10;06;25
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Our average prior authorization and financial assistance and turnaround time is two days. Our average co-pay across all patients filling at programs $7.60. Medication adherence for patients filling at program is 92%.

00;10;07;25 - 00;10;12;19
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The websites for both Pharmacy center Case management and Prep Brand Pharmacy

00;10;12;19 - 00;10;19;11
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are located on the home page. There are also available contact information if you may have more questions.

00;10;19;13 - 00;10;45;08
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Thank you for listening. Thank you for joining us and be on the lookout for our next episode. You've been listening to Sentara Health Vital Signs, a podcast for Sentara providers. As a reminder, read today's show notes for information about claiming your continuing education credits. Well, that's it for now. But we will be back soon with another episode of Vital Signs: A Podcast for Sentara Providers.

00;10;45;11 - 00;10;51;11
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