As the cost of medications skyrockets and the complexity of indications and administration techniques increases, there is a greater need for specialty pharmacies. Specialty pharmacies help streamline the drug-delivery process and facilitate prior authorizations (PAs). There are numerous specialty pharmacy models, including specialty pharmacies owned by large commercial pharmacy chains, pharmacies with pharmacy benefit managers (PBMs), and health system–owned specialty pharmacies (HSSPs). However, little is known about how effective these various practice models are in improving patient outcomes.

A retrospective chart review was conducted of 300 patients receiving oral chemotherapeutic agents through either an HSSP or external specialty pharmacy. In this analysis, rates of adherence were assessed using the medication-possession ratio (MPR) as the primary outcome and the proportion of days covered (PDC) and time to treatment (TTT) as secondary outcomes. MPR is defined as the ratio of the duration of therapy for each medication (the days’ supplied and dispensed) for each patient to the days of possession of medication. 

PDC, the gold standard for specialty pharmacy accreditation, is based on the number of days that a patient should be taking a medication rather than the prescription fill date. PDC avoids overinflating pharmacy metrics for adherence that can occur with MPR due to factoring in early, automatic refills. TTT represents the number of days from prescribing to patient receipt of the medication (i.e., the day after shipping). Whereas an MPR and a PDC threshold of >80% represents patient adherence, for some medications, such as oral chemotherapeutic agents, higher percentages are more desirable. When expressed as a ratio, a ratio of 1 for both the MPR and PDC represents 100% adherence. Data sources included information generated from the specialty pharmacy software called TherigySTM, pharmacy automation technology, patient electronic health records, and external databases from participating specialty pharmacies. 

Of the 300 study patients, 204 were included in the analysis for PDC and MPR and 164 were for TTT, although the various groups were not mutually exclusive. The patient group utilizing the internal HSSP had a higher percentage of older patients, Caucasian patients, and patients who had either government-funded insurance or who were self-pay compared with the external specialty pharmacy group. More patients patronizing the internal HSSP required a PA for their specialty medication compared with external specialty pharmacy patients. 

MPR and PDC values were statistically significant in favor of the HSSP (1.00 vs. 0.75 [P <.001] and 0.95 vs. 0.70 [P <.001], respectively), indicating that those who utilized the in-house specialty pharmacy services were more adherent to their treatment regimen. There was a trend to a shorter TTT among HSSP users, but this did not reach statistical significance. Curiously, the need for a PA was associated with better adherence. However, PA status did not affect TTT. Government-funded insurance or self-pay were associated with improved adherence. 

There was a trend towards better adherence among those whose medications were dosed once-daily compared with medications with more frequent dosing-administration times. 

An advantage of the use of HSSP was evident by a 4.21-day lower TTT. The proportion of patients who were highly adherent, which was defined as an MPR >80%, was markedly increased in the HPPS versus external specialty pharmacy group (93.33% vs. 33.33%, respectively).

For pharmacists in healthcare systems that are contemplating opening their own HSSP, this study provides objective evidence for their positive effect on patient outcomes. 

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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