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Proving Value in Specialty Pharmacy Practice: A New Yardstick

Focusing on cost alone could diminish the vital service aspects behind successfully caring for a patient in a specialty pharmacy.
Published Online: Nov 16,2017
Dan Steiber, RPh
Value-Based Contracting
Specialty pharmacy has become a focal point of data convergence. In the case of specialty products, the interpretation and action taken by specialty pharmacy in the management of pharmaceutical care—using their professional expertise to reduce abandonment and improve adherence—is the point of differentiation.

The definition of value is generally understood as the result of quality divided by cost, or the health outcomes achieved per dollar spent. Value-based contracting involves payment or reimbursement based on indicators of value, such as patient health outcomes, efficiency, and quality. To get there, we must focus on key elements, such as: the number of dollars spent on a medication versus other associated healthcare costs.

Finding specific measures and calculating how those measures can be tracked against key benchmarks. For example, one could measure the sustained virologic response test results for hepatitis C products over a period of time to measure cure rates.

Providing portability in these measures as patients may go from one plan to another over the course of their treatment.

The 4 P’s: Patient, Providers, Pharma, and Payers

All 4 of the P’s fit in the data mix. Pharma and payers are interested in seeing measurable outcomes for the drugs prescribed to patients. Pharma want to claim that their product—if used correctly—will decrease the progression of disease, reduce visits to the emergency department, and achieve positive outcomes. Pharma wants to compare their product with others on the market to point out its efficacy.

The aligned interests of payers and their specialty pharmacy operations are key. They look for products that decrease cost, reduce hospital admissions, and improve patients’ quality of life by lessening their disability and reducing absences from work due to illness. Both pharma and payer stakeholders need access to comprehensive internal data, and they look to specialty pharmacies to provide that service. Specialty pharmacies must improve their ability to better measure outcomes if they want to make valid claims that because of their actions, the health outcome for the patient was improved. Lastly, both pharma and payers are reliant on the data specialty pharmacies provide to demonstrate that a product is having a positive, not negative, impact on the patient’s condition. 

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Dan Steiber, RPh, is executive vice president and editor-in-chief of The American Journal of Pharmacy Benefits®. Professionally, he is an industry-leading consultant and has been responsible for managed markets, commercial operations, and supply chain strategy. Mr Steiber has served in several senior positions in pharmacy, distribution, and industry over the course of his 40-year career.

Mr Steiber is a licensed pharmacist in Texas, Washington, California, and Pennsylvania. He is affiliated with several professional associations and publications and is a frequent speaker on behalf of many professional organizations. He graduated from Washington State University College of Pharmacy and has participated in a variety of postgraduate programs in law and business development/marketing at Harvard University and Northwestern University. Mr Steiber currently resides in Highland Village, Texas.