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The Specialty Pharmacy Market Impact of Automated Patient Engagement & Management


Specialty Pharmacy Market Overview


Introduction: As the investment case for Digital Patient Engagement to enhance patient satisfaction and value generation within Specialty Pharmacy is increasingly recognized, few reports consider the financial impact of digital patient engagement on the labor associated with operating individual Specialty Pharmacies & market as a whole. Core Concepts: · Process for segmenting specialty pharmacies by patient volume · Estimating the entire specialty pharmacy population by segments · Assessment of current FTE costs of certain specialty pharmacy operations · Approximate financial impact of implementing automated patient engagement strategies


Estimating the Specialty Pharmacy Market Impact of Automated Patient Engagement & Management

Introduction: Specialty pharmacies seek to reduce operational costs while simultaneously finding innovative ways to increase marketplace competitiveness and acquire enhanced outcomes relationships with manufacturers and health plans. CassianRx works directly with specialty pharmacies, pharmaceutical manufacturers, and health plans. CassianRx optimizes pharmacy, Hub, and patient support operations while generating decision-level insights, automated PRO, and direct patient intervention via digital patient engagement.

Gaps in Specialty Pharmacy Patient Volume Literature: As many specialty pharmacies advance patient outcomes and reporting to manufacturers and health plans through digital patient engagement, few reports consider the financial implications of integrating automated patient tools into standard pharmacy operations. Following a literature review, it became clear that a lack of comprehensive reporting on specialty pharmacy population numbers prevents independent financial analysis on digital patient services integration. This brief analysis provides an estimate of specialty pharmacy patient numbers in the United States and predicts the potential financial impact of implementing automated pharmacy operations with CassianRx.

. Standardized Patient Management Activities for Analysis: Under URAC, ACHC, health plans, and manufacturer contracts, many specialty pharmacies perform a consistent series of patient management and reporting activities. For the purpose of this analysis, we excluded non-patient-facing operational activities, such as shipping, physician interaction & medication procurement, and instead focused on estimating the cost of the following standardized patient management activities:

  • Onboarding activities eligible for digital automation:

    • Patient Consent

    • Demographics Collection

    • Welcome packets

    • Document Signature

  • Continuous patient management activities eligible for digital automation:

    • Refill management - authorization,

    • Additional Supplies

    • Disease state clinical assessments

    • Validated clinical assessments

    • Shipping updates & notifications

Commonly, these tasks are performed manually by pharmacists and technicians, resulting in a labor and staff burden cost. Utilizing automated systems to perform these tasks reduces these costs and creates an opportunity for broader data collection, which can be harnessed for individualized care. To generate the value of these activities, we utilized common estimates of time required to complete each activity multiplied by the average FTE cost of pharmacists & technicians to complete the activity manually.

Estimating Specialty Populations by Pharmacy Tier


To investigate the potential value of digital engagement strategies, it is necessary to develop an initial estimate for the entire specialty pharmacy population. Current reports suggest between 1-2% of Americans receive specialty medications, placing this estimate between 3 million and 7 million patients. (3) However, to successfully approximate the volume of patients actively receiving specialty medications and therapy management from a specialty pharmacy, we required a more appropriate method of estimation. Utilizing published revenue and specialty prescription dispensed numbers, we approximate a monthly patient number for different tiers of specialty pharmacies organized by market share.(1,2,3) With these estimates, we extrapolate the patient population for the remainder of the specialty pharmacy population.


Model of Specialty Pharmacy Patient Volumes by Tier:

Specialty Pharmacy Patient Volume by Tier

To investigate the potential value of digital engagement strategies, it is necessary to develop an initial estimate for the entire specialty pharmacy population. Current reports suggest between 1-2% of Americans receive specialty medications, placing this estimate between 3 million and 7 million patients. (3) However, to successfully approximate the volume of patients actively receiving specialty medications and therapy management from a specialty pharmacy, we required a more appropriate method of estimation. Utilizing published revenue and specialty prescription dispensed numbers, we approximate a monthly patient number for different tiers of specialty pharmacies organized by market share. (1,2,3) With these estimates, we extrapolate the patient population for the remainder of the specialty pharmacy population.


Estimating the Value of Automated Specialty Pharmacy Services According to average market labor costs for the patient management activities included in this analysis, the typical cost of onboarding a specialty pharmacy patient Is $12.87, while the typical yearly cost of managing a patient (refills, clinical assessments, etc.) is $110.49. Now, with the population estimates derived, we approximate the cost of manual specialty pharmacy services at each pharmacy size tier, as well as throughout the full SP population.


Estimating FTE labor for standardized specialty activities
*FTE costs only include standardized patient-facing activities referenced above

When automated digital engagement tools are utilized within specialty pharmacy, between 50-70% of patients are successfully integrated into the system. Using the minimum expected patient activity completion rate of 50%, we can estimate the baseline value of implementing these changes into specialty pharmacy operations.

Estimating impact of specialty patient engagement on FTE burden for Specialty Pharmacies
*FTE costs only include standardized patient-facing activities referenced above

Discussion: Conservative estimates of the FTE impact of investing in digital patient engagement within specialty pharmacy suggests significant improvement in operational efficiency across all pharmacy tiers. Of particular interest is the potential $220,725,765.00 In cost savings generated by implementing automated services across the entire specialty population. While only an estimate, our derived number for the specialty pharmacy population of 3,900,000 patients opens the door for future investigations into the value of digital interventions across the full scope of specialty patients, as further evaluation that considers the cost of integrating digital services and incorporation of alternate patient support models within specialty pharmacy is warranted.

The Value of CassianRx: CassianRx provides value beyond improvements to operational efficiency; Cassian enhances relationships between specialty pharmacies, PBM's, and pharmaceutical manufacturers. Cassian embeds manufacturer programs directly into specialty pharmacy hubs, CRMs, and websites, helping to automate the gaps between patient education, medication access, and refills, all while promoting adherence and persistence to therapy. For more information, please reach out to Collin.Wolf@CassianRx.com or visit https://cassianrx.com



 

About the Author


Jacob Lombardi

Jacob Lombardi is a fourth-year Doctorate of Pharmacy candidate at the University of Pittsburgh.



 


Endnotes:

2. Drug Channels. “Top 15 Specialty Pharmacies of 2022”. https://www.drugchannels.net/2023/04/dcis-top-15-specialty-pharmacies-of.html.

3. Evernorth “2020 Drug Trend Report”. https://www.evernorth.com/drug-trend-report/utilization-and-costs.

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