ABC Health Plan Specialty Pharmacy Presentation

Report
Fairview Specialty Pharmacy
Fairview Specialty Pharmacy
Fairview Pharmacy Services, LLC
‘Specialty Drug’ - Definition
• Complex, high cost products that require additional support and are
often used to treat chronic conditions.
• Many are biologics, many are injectable.
• UPlan’s Definition:
“Specialty Prescription Drugs” - shall mean those Prescriptions and other
pharmaceutical products, services and supplies listed in Exhibit 1.32 and
dispensed by Participating Pharmacies for complex, chronic and high-dollar
health care conditions to a Member for which coverage is provided pursuant
to the terms and conditions of the Health Plan. Specialty Pharmacy drugs
are complex injectable and oral drugs that have very specific manufacturing,
storage, and/or dilution requirements. Specialty drugs are used to treat
serious or chronic medical conditions such as multiple sclerosis, hemophilia,
hepatitis and rheumatoid arthritis.
Typical Specialty Conditions
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Allergic Asthma
Anemia/Neutropenia
Crohn’s Disease
Cystic Fibrosis
Enzyme Replacement Therapy
Growth Hormone
Hepatitis C
Hemophilia
Hereditary Angioedema
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Infertility
Multiple Sclerosis
Oncology
Osteoporosis
PKU
Psoriasis
Psoriatic Arthritis
Pulmonary Hypertension
Rheumatoid Arthritis
Costs of Specialty Therapies
Typical Annual Rx Expense
Disease States
Anemia/Neutropenia
Crohn’s Disease
Cystic Fibrosis
Growth Deficiency
Hepatitis C
Infertility
Multiple Sclerosis
Oncology
PKU
Psoriasis
Pulmonary Hypertension
Rheumatoid Arthritis
Annual Rx Expense
$10,000
$20,000
$30,000
$25,000
$25,000
$2,400
$20,000
up to $50,000+
up to $200,000+
$20,000
up to $250,000
$20,000
Specialty Drugs
Anemia/Neutropenia
Procrit
Epogen
Aranesp
Neupogen
Neulasta
Crohn’s Disease
Humira
Cimzia
Cystic Fibrosis
Pulmozyme
Tobi
Growth Hormone
Norditroin
Genotropin
Humatrope
Nutropin
Saizen
Omnitrope
Tev-Tropin
Increlex
Hepatitis C
Pegasys
Peg-Intron
Ribavirin
Infertility
Bravelle
Follistim
Ganrilex
Menopur
Novarel
Repronex
Cetrotide
Ovridel
Gonal-F
Multiple Sclerosis
Rebif
Copaxone
Avonex
Betaseron
Ampyra
Gilenya
Oral Oncology
Gleevec
Hycamtin
Lysodren
Matulane
Nexavar
Revlimid
Sutent
Tarceva
Targretin
Tasigna
Thyalomid
Tykerb
Votrient
Xeloda
Zolinza
Osteoporosis
Forteo
Psoriasis
Enbrel
Humira
Amevive
Pulmonary Hypertension
Revatio
Adcirca
Letaris
Psoriasis
Enbrel
Humira
Amevive
Rheumatoid Arthritis
Enbrel
Humira
Kineret
Cimzia
Simponi
UPlan Specialty Drug List
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Fairview Specialty Pharmacy and Duluth only:
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Fairview Specialty Pharmacy and Retail Network:
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Growth Hormone
Hemophilia
Multiple Sclerosis
Rheumatoid Arthritis/ Crohn’s/ Psoriasis
Oral Oncology
Cystic Fibrosis
Anemia/ Neutropenia
HIV
Transplant
Infertility
Hematology (Lovenox, Arixtra)
Limited Distribution Products
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Fairview Specialty Pharmacy triages to contracted specialty pharmacy (Tri-essent first)
Grace Fill Policy
• UPlan allows members one month grace fill at retail
• Prime sends list of ‘Specialty Only’ drugs filled at retail to Fairview
• Fairview outreach to member
– Pro-active call
– Explanation of Specialty Pharmacy benefit
– Transfer prescription to Fairview or eligible Duluth pharmacies
Typical Specialty Pharmacy Services
• Inventory Specialty Products and Ancillary Supplies
• Refill Reminder Phone Calls/Delivery Coordination
• 24-hour Availability
• Free Shipping and Ancillary Supplies
• Temperature-controlled Shipping
Fairview Specialty Pharmacy - Additional Services
‘Big Enough Yet Small Enough’
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Personal, Sophisticated Customer Service
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Patient Financial Advocates (PFA)
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Courier to 18 surrounding counties
Same day delivery if received by 2 PM
Fertility Pharmacy Network
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Assigned to each specialty patient
Courier and Pick-up Options
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All calls answered live by an experienced pharmacy technician
15 locations
Decrease waste
Part of Fairview Health System
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Pharmacists part of care team
Access to medical record
Specialty Therapy Management
Goal: Improve patient outcomes
We know:
Specialty therapies improve outcomes
but …
We also know:
Patients do not take medications the way they should, or in
the way it was studied to produce published results
Disease specific algorithms enable us to:
• Ensure standards of care are consistently followed
• Monitor therapy to detect and resolve problems
- Identify opportunities for referral to MTM, PFA, Clinic,
Pharmacist
• Pro-actively identify opportunities to keep patients on therapy
• Help patients become better informed about their therapy so they
can more actively take charge of it
Therapy Management - Scope
• Therapy timeline – a ‘plan’
- At initiation: Patient assessment and education
‘ Setting the patient up right’
- Ongoing: Scheduled patient monitoring, therapy reviews and patient
reassessment
‘Keeping the patient on course’
• Case management system allows improved documentation and data
capture
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At Initiation: Patient assessment and education
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Product education
Injection training
Disease specific assessments (e.g., functional level, recent exacerbations, viral loads,
genotypes)
Individualized letter to patient and healthcare provider
• Ongoing: Scheduled patient monitoring, therapy reviews and patient
reassessment
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Targeted Questions
Ongoing education and reinforcement
Compliance assessment
Side effect management strategies
Injection technique assessment and re-training
Depression assessments
Disease specific assessments
Interventions
Individualized letters to patients and healthcare provider
Referral to MTM, PFA, or healthcare provider if indicated
• Therapy timeline – a “plan”
• At initiation: Patient assessment and education
• Ongoing: Scheduled patient monitoring, therapy reviews
and patient reassessment
- Surveys
- Interventions
- Side effect management
- Individualized letters to patients and physicians
- Referrals to MTM
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Documentation

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