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7 Factors Payors Should Consider When Choosing a Specialty Pharmacy Partner

Patients and their families who are facing a rare disease or complex condition require much more than just a prescription. They require ongoing support such as therapy management, help with financial assistance programs, coordination of complex care programs and much more. This type of comprehensive healthcare service is essential for a specialty pharmacy to deliver best-in-class care, while developing customized programs for payors to achieve high medication compliance and improved outcomes.

For payors contracting with a specialty pharmacy partner, there are 7 important factors to take into consideration to ensure a successful partnership that maximizes benefits for their members.

Coordinated Care:  Look for a specialty pharmacy that coordinates care between the prescriber, site of care and patient to ensure that the safety and appropriateness of the therapy regimen aligns with the prescriber’s orders. This coordination eases treatment burden, improves quality of care, ensures expected outcomes and reduces spending associated with unnecessary hospitalizations or visits to the Emergency Department (ED). In addition to providing coordinated care, Orsini Specialty Pharmacy also helps avoid over-utilization, repeat diagnostic testing, repeat medical histories, multiple prescriptions and adverse drug interactions.

Comprehensive Care Management: Does the specialty pharmacy develop therapy-specific programs that provide education, guidance, and interventional interactions to enable members to better manage their condition? By helping your members integrate their therapy into their everyday lives, they will find it easier to take ownership of their condition which can result in incremental health improvements that drive a lower cost of care. Orsini’s experienced clinicians provide counseling on drug administration and storage, adherence tips, encouragement and side effect management.

Coordination of Benefits:  Consider a specialty pharmacy that performs an in-depth benefits investigation to determine if the patient has access to multiple payors, co-pay programs, and third-party foundation support. This ensures the appropriate primary, secondary and tertiary payor is billed, which can result in savings to the member and the payor.

In-Home Patient & Family-Centric Care: Look for a specialty pharmacy that provides nursing services for members to receive treatment at home, or receive training on self-administered drugs. Orsini Specialty Pharmacy administers a nationwide nursing network, with nurse coordinators who collaborate with members and their families to provide clinical education and coaching that strengthen a their capacity towards goal achievement, resulting in improved clinical and psychosocial outcomes.

Cost Avoidance: Does the specialty pharmacy have the expertise and experience to help manage costs throughout a member’s treatment journey? A majority of the therapies that Orsini dispenses are high-cost, lifelong maintenance therapies intended to allow a patient with a rare disease or complex condition to live their best life possible. Orsini’s therapy care teams approach drug cost avoidance in a number of ways, including the following:

  • On-hand inventory verification by the therapy care team, pharmacist, or for infused therapies, by a nurse in the home
  • For all of our conditions, we tailor our counseling calls to each patient’s situation to prevent avoidable health care costs, including hospital ED visits or unnecessary admissions.
  • We regularly perform “days’ supply optimization” to make certain members have the correct amount of medication on hand and to avoid stockpiling.

Data Reporting: Consider a specialty pharmacy that provides you with critical metrics that are important to you. Orsini Specialty Pharmacy’s proprietary system collects critical metrics on clinical demographics, interventions and outcomes so they can refine program models and formulary designs in line with the needs of their customer base.

Accreditations: It’s important to look into the accreditations that the specialty pharmacy has achieved to see what sets them apart from others to best support patients. Orsini Specialty Pharmacy holds the following accreditations.

These are all important factors that payors should consider when choosing the right specialty pharmacy partner to serve their members. Everything from adherence, coordination of care, member benefit research, data analytics, and more go into the decision to contract with specialty pharmacies. If you’re interested in seeing how Orsini Specialty Pharmacy can partner with your organization, schedule a call and learn more about our customized plans and services for payor organizations.