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Fairview Specialty Pharmacy
Fairview Pharmacy Services, LLC
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‘Specialty Drug’ - Definition
Complex, high cost products that require additional support and are often used to treat chronic conditions. Many are biologics, many are injectable. UPlan’s Definition: “Specialty Prescription Drugs” - shall mean those Prescriptions and other pharmaceutical products, services and supplies listed in Exhibit 1.32 and dispensed by Participating Pharmacies for complex, chronic and high-dollar health care conditions to a Member for which coverage is provided pursuant to the terms and conditions of the Health Plan. Specialty Pharmacy drugs are complex injectable and oral drugs that have very specific manufacturing, storage, and/or dilution requirements. Specialty drugs are used to treat serious or chronic medical conditions such as multiple sclerosis, hemophilia, hepatitis and rheumatoid arthritis.
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Typical Specialty Conditions
Allergic Asthma Anemia/Neutropenia Crohn’s Disease Cystic Fibrosis Enzyme Replacement Therapy Growth Hormone Hepatitis C Hemophilia Hereditary Angioedema Infertility Multiple Sclerosis Oncology Osteoporosis PKU Psoriasis Psoriatic Arthritis Pulmonary Hypertension Rheumatoid Arthritis
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Costs of Specialty Therapies
Typical Annual Rx Expense Disease States Annual Rx Expense Anemia/Neutropenia $10,000 Crohn’s Disease $20,000 Cystic Fibrosis $30,000 Growth Deficiency $25,000 Hepatitis C Infertility $2,400 Multiple Sclerosis Oncology up to $50,000+ PKU up to $200,000+ Psoriasis Pulmonary Hypertension up to $250,000 Rheumatoid Arthritis
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Specialty Drugs Anemia/Neutropenia Hepatitis C Oral Oncology Psoriasis
Procrit Pegasys Gleevec Enbrel Epogen Peg-Intron Hycamtin Humira Aranesp Ribavirin Lysodren Amevive Neupogen Matulane Neulasta Infertility Nexavar Pulmonary Hypertension Bravelle Revlimid Revatio Crohn’s Disease Follistim Sutent Adcirca Ganrilex Tarceva Letaris Cimzia Menopur Targretin Novarel Tasigna Cystic Fibrosis Repronex Thyalomid Pulmozyme Cetrotide Tykerb Tobi Ovridel Votrient Gonal-F Xeloda Growth Hormone Zolinza Norditroin Multiple Sclerosis Rheumatoid Arthritis Genotropin Rebif Humatrope Copaxone Osteoporosis Nutropin Avonex Forteo Kineret Saizen Betaseron Omnitrope Ampyra Simponi Tev-Tropin Gilenya Increlex
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UPlan Specialty Drug List
Fairview Specialty Pharmacy and Duluth only: Growth Hormone Hemophilia Multiple Sclerosis Rheumatoid Arthritis/ Crohn’s/ Psoriasis Oral Oncology Cystic Fibrosis Anemia/ Neutropenia Fairview Specialty Pharmacy and Retail Network: HIV Transplant Infertility Hematology (Lovenox, Arixtra) Limited Distribution Products Fairview Specialty Pharmacy triages to contracted specialty pharmacy (Tri-essent first)
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Grace Fill Policy UPlan allows members one month grace fill at retail
Prime sends list of ‘Specialty Only’ drugs filled at retail to Fairview Fairview outreach to member Pro-active call Explanation of Specialty Pharmacy benefit Transfer prescription to Fairview or eligible Duluth pharmacies
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Typical Specialty Pharmacy Services
Inventory Specialty Products and Ancillary Supplies Refill Reminder Phone Calls/Delivery Coordination 24-hour Availability Free Shipping and Ancillary Supplies Temperature-controlled Shipping
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Fairview Specialty Pharmacy - Additional Services
‘Big Enough Yet Small Enough’ Personal, Sophisticated Customer Service All calls answered live by an experienced pharmacy technician Patient Financial Advocates (PFA) Assigned to each specialty patient Courier and Pick-up Options Courier to 18 surrounding counties Same day delivery if received by 2 PM Fertility Pharmacy Network 15 locations Decrease waste Part of Fairview Health System Pharmacists part of care team Access to medical record
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Specialty Therapy Management
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Goal: Improve patient outcomes We know: Specialty therapies improve outcomes but … We also know: Patients do not take medications the way they should, or in the way it was studied to produce published results
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Disease specific algorithms enable us to:
Ensure standards of care are consistently followed Monitor therapy to detect and resolve problems - Identify opportunities for referral to MTM, PFA, Clinic, Pharmacist Pro-actively identify opportunities to keep patients on therapy Help patients become better informed about their therapy so they can more actively take charge of it
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Therapy Management - Scope
Therapy timeline – a ‘plan’ - At initiation: Patient assessment and education ‘ Setting the patient up right’ - Ongoing: Scheduled patient monitoring, therapy reviews and patient reassessment ‘Keeping the patient on course’ Case management system allows improved documentation and data capture
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At Initiation: Patient assessment and education
Product education Injection training Disease specific assessments (e.g., functional level, recent exacerbations, viral loads, genotypes) Individualized letter to patient and healthcare provider Ongoing: Scheduled patient monitoring, therapy reviews and patient reassessment Targeted Questions Ongoing education and reinforcement Compliance assessment Side effect management strategies Injection technique assessment and re-training Depression assessments Disease specific assessments Interventions Individualized letters to patients and healthcare provider Referral to MTM, PFA, or healthcare provider if indicated
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Therapy timeline – a “plan”
At initiation: Patient assessment and education Ongoing: Scheduled patient monitoring, therapy reviews and patient reassessment Surveys Interventions Side effect management Individualized letters to patients and physicians Referrals to MTM Documentation
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