Benefits of developing a collaborative, outcomes-based specialty pharmacy program.

Area of Science:

• Pharmacy Practice
• Health Services Research
• Health Economics

Background:

• Specialty pharmacy spend is rapidly increasing.
• Risk-based payment models are being implemented.
• Opportunities exist for collaborative specialty pharmacy contracts.

Purpose of the Study:

• To describe the benefits of a collaborative, outcomes-based specialty pharmacy program.
• To detail a specific contract between a health system and a third-party payer.
• To highlight the differentiation achieved through this model.

Main Methods:

• Establishment of a contract between University of Wisconsin (UW) Health and Unity Health Plans Insurance Corporation.
• Definition of standards for patient management, pharmacist training, EMR documentation, and prescription fulfillment.
• Requirement for annual reporting on compliance, persistence, and outcomes metrics.

Main Results:

• The contract focuses on core services and longitudinal patient care, rather than solely on dispensing reimbursement.
• It establishes clear standards for specialty pharmacy practice.
• The model provides ancillary benefits by elevating ambulatory care pharmacy practice standards.

Conclusions:

• Collaborative development of practice standards and patient management protocols rapidly elevates specialty pharmacy services.
• This model offers significant differentiation in the competitive specialty pharmacy and payer markets.
• The contract enhances patient care processes and outcomes.