specialty pharmacy

In this episode, Sarah Hayward, PharmD, BCOP, and Amy Ly Indorf, PharmD, BCOP, discuss their experiences providing care for patients with advanced ovarian cancer, with topics including:

• PARP inhibitors as frontline maintenance therapy
• Patient education and counseling on PARP inhibitors
• Helping patients access newer therapies
• Experiences with mirvetuximab soravtansine
• Patient education and counseling on mirvetuximab soravtansine
• Treatment modalities on the horizon 

Presenters:

Sarah Hayward, PharmD, BCOP
Clinical Pharmacy Specialist,
Gynecologic Oncology
Stephenson Cancer Center at
OU Health
Oklahoma City, Oklahoma

Amy Ly Indorf, PharmD, BCOP
Clinical Assistant Professor
University of Washington 
School of Pharmacy
Clinical Oncology Pharmacist
UW Medicine
Fred Hutchinson Cancer Center
Seattle, Washington

Supported by educational grants from GSK and Novocure, Inc.

Link to full program:
https://bit.ly/44fUiOU

Dr. John Neil is the Executive Vice President and Chief Physician Executive and Network Strategy Officer for HonorHealth in Scottsdale, Arizona. Dr. Neil drives physician engagement throughout HonorHealth, working to ensure that physicians have input and involvement in the decision-making processes of the healthcare system. His work with clinical teams focuses on strategic initiatives, operations, clinical services and the continuum of patient care.

An interventional radiologist by clinical training, he joined HonorHealth as the organization’s senior physician leader in 2015 and has since held leadership roles with the organization's medical staff, Scottsdale Health Partners, and the HonorHealth Board of Directors. His professional experience includes serving as the chairman of Southwest Medical Imaging, a large radiology practice that has been active in ambulatory development, practice mergers and joint ventures.

Dr. Neil holds a bachelor's degree in biochemistry from the University of Kansas and graduated with honors from Washington University School of Medicine.

John Marchica, CEO, Darwin Research Group

John Marchica is a veteran health care strategist and CEO of Darwin Research Group. He is leading ongoing, in-depth research initiatives on integrated health systems, accountable care organizations, and value-based care models. He is a faculty associate in the W.P. Carey School of Business and the graduate College of Health Solutions at Arizona State University.

John did his undergraduate work in economics at Knox College, has an MBA and M.A. in public policy from the University of Chicago, and completed his Ph.D. coursework at The Dartmouth Institute. He is an active member of the American College of Healthcare Executives and is pursuing certification as a Fellow.

About Darwin Research Group

Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.

Host:

• Ken Perez, Vice President, Healthcare Policy and Government Affairs

Guest Experts

• Sarah Kester, PharmD, Pharmaceutical Program Manager, Omnicell Specialty Pharmacy Services
• Matt Manning, PharmD, Senior Director of Operations, Health Systems, Omnicell Specialty Pharmacy Services

Episode Highlights

Q: What does an advanced clinical adherence monitoring program entail and what does the Omnicell Specialty Pharmacy Services team do to impact adherence to XIFAXAN?

Sarah Kester:The process for our team starts at the very beginning of the lifecycle of the prescription. In a typical big box or PBM pharmacy scenario, when a prescription for XIFAXAN is received and prior authorization (PA) is needed, then the pharmacy would send that insurance rejection back to the provider and basically do nothing until they hear back from the provider that the prescription has been approved. Meanwhile, the patient languishes without their medication. 

When you send your prescription to your health-system-owned pharmacy, as soon as we receive the referral and it's determined that a PA is needed, the pharmacy goes right to work on completing the PA. Our team members are very well versed in the requirements for PAs and we have a PA approval rate of over 92%. 

Once your PA is approved, then our clinical team takes over and we contact the patients. We provide them with in-depth counseling, check for any drug interactions, and educate the patient on the medication and desired outcomes for treatment. 

After the initial counseling and delivery of the medication, we continue to perform clinical follow up on a monthly basis for each patient. Seven to ten days before their refill is due, follow up calls are made to every patient. At that time, we monitor for side effects, efficacy of the medication, and any hospitalizations the patient may have experienced. We also provide monthly reminders that the patient should be on this medication for long-term maintenance and should not stop unless directed by their provider. We provide 36 months of follow up for the patient as part of our partnership with Bausch

Q: Now Sara, what benefits do you see from this intensive follow up with patients?

Sarah Kester: Our most important finding is the increase in days on therapy for our patients versus the national average. The average days on therapy for all XIFAXAN patients is around 5.4 months. However, patients that participate in our program are on therapy for about 9 months. 

What's the importance of a patient getting a few more months of treatment? Quite simply, it results in patients living longer, having a better quality of life, and staying out of the hospital. 

One of my favorite stories involves a patient who started on our program after being prescribed XIFAXAN after an episode of hepatic encephalopathy. This episode of HE resulted in him losing his driving privileges. When we started out, we had to speak with his caregiver because his cognitive deficit was too great for him to speak with us directly. But, after getting him established on treatment, his symptoms abated and now we're able to speak with him. He was even able to start driving again and every month he mentions that when we do our follow up. Getting his freedom to be independent back was such a great experience for him.

Q: Let's take this up a level. Patient adherence is just one of the many challenges associated with operating a specialty pharmacy and optimizing results. Matt, what are some other common core challenges that impact specialty pharmacies and how can health systems ensure they are positioned for success?

Matt Manning:There are a lot of considerations when it comes to launching and scaling a specialty pharmacy and we're energized to support health systems and position them for success.  Let's start with manufacturer relations. Manufacturer limited drug distribution can be a huge barrier for a new specialty pharmacy. Many drugs today are distributed through a limited network of pharmacies at the discretion of the manufacturer. These drugs could be limited for a variety of different reasons — whether it's REMS considerations, storage considerations, or cost. 

I recently read that 48% of the specialty pharmacy pipeline consists of products aimed to treat orphan disease states. When you include Oncology, that number is 80%. Those are the hallmark disease states that are going to be challenging to get access to. A new specialty pharmacy will need to validate its operation, providing manufacturers with confidence that they possess the capabilities and expertise necessary to handle their drug and serve patients.  

Omnicell Specialty Pharmacy Services wants to ensure you gain access to limited distribution drugs as quickly as possible. We support this effort through our existing manufacturer relationships and SOPs. We’re able to have great conversations with manufacturers regarding their products anchored in the SOPs, policies, and programs we’ve developed to convince these drugmakers to grant LDD access to the specialty pharmacies we partner with.

Another core consideration is access to payment networks. Again, these are limited for a variety of different reasons. Payers will restrict certain products and medications and patients to be serviced through their preferred pharmacy operation.

We really take a unique approach to addressing the barriers of access to payer networks. Omnicell Specialty Pharmacy Services manages its own PSAO. This allows us to get into a majority of networks very quickly and allows our team to help support audits, payer relations, and negotiations. 

Another consideration is capture rate. What I mean by that is the value of medications being sent to your pharmacy. We're thinking about helping a health system build a lucrative specialty pharmacy business. From this perspective, we work with health systems to examine the different clinicians and specialties driving specialty prescriptions in their organization. We determine which of these providers and operations should be prioritized, and we measure ourselves on that. Our goal is typically a 75% prescription capture rate, meaning referrals coming into the health system-owned specialty pharmacy. This translates to savings and revenue growth for our health system partners. 

Many diseases are so rare that they are often misdiagnosed -- and, even if diagnosed properly, some therapies only treat the symptoms, not the underlying disease. But there's new hope for those who suffer from a rare disease, and the health care field is certainly looking at new approaches to treating them. Erin Satterwhite, President & GM of Optum Frontier Therapies, offers her insights.

Ameet Wattamwar, PharmD, is the Director of Specialty Pharmacy for the NYU Langone Hospitals System. Prior to this role, he was Vice President of Client Strategies for PHS, AmerisourceBergen’s health system facing consulting arm where he specialized in specialty & ambulatory pharmacy development, 340b optimization, and other pharmacy centric cost savings, and efficiency-focused initiatives. Ameet has also consulted for pharmaceutical manufacturers in addition to practicing pharmacy across various care settings.

John Marchica, CEO, Darwin Research Group

John Marchica is a veteran health care strategist and CEO of Darwin Research Group, a health care market intelligence firm specializing in health care delivery systems. He’s a two-time health care entrepreneur, and his first company, FaxWatch, was listed twice on the Inc. 500 list of fastest-growing American companies. John is the author of The Accountable Organization and has advised senior management on strategy and organizational change for more than a decade.

John did his undergraduate work in economics at Knox College, has an MBA and M.A. in public policy from the University of Chicago, and completed his Ph.D. coursework at The Dartmouth Institute. He is a faculty associate in the W.P. Carey School of Business and the College of Health Solutions at Arizona State University and is an active member of the American College of Healthcare Executives.

About Darwin Research Group

Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.

WTP sits down (virtually of course) with Luba Sololevsky, Executive Director of the Immunoglobulin National Society. Also known as IgNs. 

IgNS is a professional organization dedicated to developing and sustaining the advancement of knowledge, education, and the practice of nursing and pharmacy in the field of immunoglobulin therapy.

If you are having trouble getting pregnant, what are some things you should consider before starting infertility treatment. We talk with Nancy Harrington, an infertility nurse for over 20 years and a senior specialist of clinical education at AllianceRx Walgreens Prime. 

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This week, John sits down with Brett McClain, chief operating officer for Dignity Health’s St. Joseph’s Hospital and Medical Center, where he recently oversaw the launch of Dignity’s systemwide specialty pharmacy. Brett speaks to the development of the specialty pharmacy through a strategic partnership, how pharma engages with his health system, the Dignity-CHI merger, and more.

Speaker Bios
Brett McClain is the Chief Operating Officer for Dignity Health’s St. Joseph’s Hospital and Medical Center, and St. Joseph’s Westgate Medical Center. Brett has been with Dignity Health since 2008. His career spans nearly 25 years of health care management experience overseeing various hospital and medical clinic operations. He is an active leader within St. Joseph’s Hospital and Medical Center with roles in a variety of operational and strategic committees and councils. Brett earned degrees in both finance and marketing from the University of Arizona and an MBA from Regis University. He is a Fellow of the National Association of Public Hospitals and board member of Catholic Charities.

John Marchica is a veteran health care strategist and CEO of Darwin Research Group, a health care market intelligence firm specializing in health care delivery systems. He’s a two-time health care entrepreneur, and his first company, FaxWatch, was listed twice on the Inc. 500 list of fastest growing American companies. John is the author of The Accountable Organization and has advised senior management on strategy and organizational change for more than a decade. John did his undergraduate work in economics at Knox College, has an MBA and M.A. in public policy from the University of Chicago, and completed his Ph.D. coursework at The Dartmouth Institute. He is a faculty associate in the W.P. Carey School of Business and the College of Health Solutions at Arizona State University, and is an active member of the American College of Healthcare Executives.

About Darwin Research Group
Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.