Specialty Rx partnership with Diplomat helps McKesson’s independents level the playing field
SAN DIEGO — Phil Hagerman, CEO and Chairman of Diplomat Pharmacy, Inc., joined attendees as a special guest speaker for a “Specialty Lunch and Learn,” at McKesson’s ideaShare 2015. “Specialty is the new pharmacy,” Hagerman said.
Currently, the specialty pharmacy market stands at $100 billion and is growing at a 20% trajectory. More than half of all new drugs approved in 2014 were specialty medicines, and eight of the top 10 best-selling drugs are expected to be in the specialty channel by 2016. By 2017, spending on specialty medicines is anticipated to represent 50% of the overall drug spend.
McKesson understands that specialty patients have unique needs and it can be very expensive and time consuming for a pharmacy to build capabilities to manage these patients. McKesson’s partnership with Diplomat brings the supportive specialty pharmacy services to local independent pharmacies without the upfront investment. The independent pharmacy continues to adjudicate the specialty claim and get reimbursed; Diplomat provides the wrap around access, reimbursement and clinical services, to enable a consistent and efficient level of care to all key stakeholders including the pharmacy, prescriber and patient.
As a pharmacist, Hagerman knows that managing all of these services in house can be challenging. “Historically, the prior authorization and funding support process is the hardest thing for a retailer,” Hagerman said. As many as 4-out-of-5 specialty drugs require a prior authorization. “Our overall 2014 success rate on prior authorization on first pass is 86%,” Hagerman said. “And our overall 2014 prior authorization on appeals is 83%. We want to help our retail partners with this process.”
In addition to providing the specialty services, retail pharmacies have also been faced with an increase in the number of limited distribution drugs. “Limited distribution is a challenge, but I would say it’s one of the biggest opportunities for independent pharmacies, because if you have a specialty physician in your community, the most important thing you can do is get him to trust that whatever patient prescriptions he sends to you, you will take care of,” Hagerman said. “That doesn’t mean you will always be able to fill the prescription, but it does mean that you’ll take care of the patient.” Failing to meet a specialty patient’s needs is the kiss of death for a pharmacy. Delivering on those needs; however, brings a high-cost patient through your door — a patient who also is quite likely to also be on a high number of maintenance prescriptions.
The McKesson Diplomat relationship enables a participating store to send any limited distribution drugs to Diplomat in a non-predatory relationship. The patient is staying with their local store, just the one specialty script that can’t be filled locally will be sent from Diplomat to the patient. “We want to keep the retail store whole and keep their patients happy,” Hagerman said.
Once the store chooses to participate in the program, it is important to make it known to both area doctors and pharmaceutical reps that specialty prescriptions can be filled at your store. This is a critical patient acquisition tool, Hagerman added. “Even if the pharmaceutical rep is not your friend today and he’s sending everything to another pharmacy, when the doctor calls him with a problem, that rep has to have a solution,” Hagerman said. “You are that solution. Do not discount how important that is.”