While studies showing
employers are spending 40% of their drug costs on just 1% of all prescriptions,
it’s never been more important for payers to partner with high-quality
pharmacies and professionals at the top of their game.
In
fact, it’s only going to become more important, says Heather Bonome, Director,
Pharmacy at URAC, as many studies project
that the 40% drug cost figure could climb to 60% over the next several years.
When it comes to handling complex, expensive prescriptions such as biologic
injectables, “there is so much more to being a pharmacist than counting pills”
Bonome says.
Willis
Tower Watson recently published a study that found that only ten drugs
accounted for a full 20% of employers’ total pharmacy spend in 2018. In the
report, Nadina Rosier, Pharm.D., and Head of Pharmacy practice at WTW added,
“Pharmacy represents about 20% of employers’ overall health care spend and is expected
to reach 25% by 2020.”
This
dynamic puts a lot of pressure on pharmacies, Bonome says. They are being asked
to dispense expensive and complex injectables and help ensure the prescription
is the right fit for the individual patient. “Specialty pharmacists, trained
properly, can provide critical clinical, financial and educational input to
ensure these complex drugs are taken properly, avoiding potential harm to the
patient and waste of valuable product,” Bonome says.
However,
it’s not always easy for a payer or other customer to gauge the credentials of
a pharmacy. Specialty pharmacies are regulated on a state-by-state basis and
state regulations focus on general operational functions that are not specific
to specialty medications. URAC’s Specialty Pharmacy Accreditation Program
requires adherence to several key areas in addition to the requirements set out
by pharmacy regulations.
Bonome
cited Patient Management as a big differentiator in the URAC program. Because
it is so important that these expensive and complex medications to be taken
properly, it is imperative that the pharmacy conduct an initial clinical
assessment to make sure the drug is right for the patient and periodically
monitor the patient for adherence, side effects and efficacy.
Patients
also need to be trained on how to effectively administer their medications;
they need to understand potential side effects, and they need to understand
when and how best to keep the pharmacist informed of their progress. Otherwise,
“patients sometimes stop taking the medication for the wrong reason” Bonome
says. In that scenario, the patient is losing out on the benefits of the
treatment, and the payer is incurring a large cost for on a product that’s not
being used.
URAC
standards also require a clinician be available 24/7. It doesn’t mean the
pharmacy itself must be open, but the accredited operation must have a
qualified clinician on call to answer patient or physician questions about
these complex drugs.
Another
key area covered by the URAC standards is cold-chain management. Because many
of these expensive drugs are sensitive to temperature fluctuations, it’s
imperative that they are shipped in secure containers that preserve steady
temperature integrity. URAC’s standards address specific packaging and
temperature management procedures and require a validated product-delivery
program backed with rigorous testing.
It’s a
higher bar to clear, designed to give a high level of confidence to patients,
manufacturers, payers, employers and insurers, knowing they are working with an
URAC-accredited specialty pharmacy, Bonome says. “Meeting the requirements of
URAC accreditation demonstrates the specialty pharmacy is providing
high-quality clinical care,” she adds.
For
more information or to request a quote on our specialty pharmacy accreditation
program, visit our Specialty Pharmacy webpage.
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