Road Map to Starting a Specialty Pharmacy

Transcription

1 Road Map to Starting a Specialty Pharmacy Nine Essential Destinations on the Route to Success Written in conjunction with Mediware and Suzette DiMascio, President/CEO of CSI Specialty Group MEDIWARE Mediware.com

2 CONTENTS Introduction 1 Determine Your Mode of Transport 2 Plan Your Route 2 Prepare for the Journey 3 Choose Experienced Staff for the Trip 3 Invest In Technology to Ensure a Smooth Ride 4 Streamline Your Route with a Strong Sales Team 4 Train Your Staff To Ensure You Arrive at Your Destination 5 Keep Your Journey Going with Accreditation 5 Continue Beyond Your Original Destination with Consistently Excellent Service 6 References 7 About 7 Introduction The number of specialty pharmacies which provide expensive and/or difficult-to-administer medications that treat complex conditions has grown rapidly in the last decade. Nevertheless, the specialty pharmacy market is still viable. In fact, less than 50 percent of payers are satisfied with the measuring and documenting of their specialty pharmacy provider s (SPP) services. In addition, there is significant potential for continued growth because 70 percent of biologics currently in development are those that are likely to be administered by specialty pharmacies. 1 So, while market conditions remain favorable, the process of starting a specialty pharmacy is a journey with several significant destinations along the route. This road map will help you find your way. less than 50% payers that are satisfied with the measuring and documenting of their specialty pharmacy provider s (SPP) services 70% of biologics currently in development are likely to be administered by specialty pharmacies 1 EMD Serono Specialty Digest, 10 th Edition; 1

3 1. Determine Your Mode of Transport Specialty pharmacies can be established in three ways. You can partner with someone currently providing specialty pharmacy services, buy an existing business, or build your own from the ground up. Determine which method of entry into the market best suits your situation. Select partners who can help plan your route. PARTNER easy entry into the market immediate access to limited-distribution drugs, payer accounts and experienced staff smallest financial investment BUY easy entry into the market immediate access to limited-distribution drugs, payer accounts and experienced staff popular with larger organizations, many of which have purchased smaller but successful specialty pharmacies likely to be a significant financial investment BUILD can create your own niche longest time to enter the market many potential roadblocks, such as access to patients, prescriptions, drugs, payer accounts and experienced staff 2. Plan Your Route Before you hit the road, map out the direction you want your business to go, and develop a plan to create your own brand destination. Define your capabilities, and decide which disease states you can best serve. determine what services you currently provide that can be adapted select partners who can help, if needed pick consultants with current specialty pharmacy expertise 2

4 3. Prepare for the Journey Among the most important tools you ll need for the journey of successfully entering the market is access to prescriptions, patients and limited-distribution drugs. Relationships are critical to gaining and maintaining access, so nurture existing relationships, and be prepared to consistently delight everyone you serve, from prescribers to payers. Relationships are critical to gaining and maintaining access. access prescriptions through relationships with physicians access patients through managed care contracts access limited-distribution drugs through group purchasing organizations (GPO) 4. Choose Experienced Staff for the Trip The right employees, who know the industry and have established relationships, can help you navigate the route from startup to long-term success and avoid potential potholes along the way. Seek employees who are familiar with the market and its key stakeholders as well as those with experience handling billing, claims and other operational functions. An experienced clinical team, including nurses, technicians and care coordinators, is also critical to success in the marketplace. Look for employees who are passionate about the industry and whose passions align with your company s values. look for employees who are passionate about the industry and whose passions align with your company s values hire consultants, if needed, to help acquire valuable talent 3

5 5. Invest In Technology to Ensure a Smooth Ride Steer clear of potholes by selecting technology products that are designed for the complex and specialized services of a specialty pharmacy. Platforms suitable to the specialty market should be scalable and should include an interface for prior authorizations (PA). They should also be able to handle medical billing as well as manage dispensing and inventory. Retail pharmacy software is not designed to meet these needs. In addition, your technology tools should be capable of analyzing the available data, so you are always aware of trends in your business, which will help you stay on course. The data available from your technology can also help you to equip your sales staff with marketable facts about your business and report detailed information to drug manufacturers and suppliers. Attempting to adapt retail software to the specialty pharmacy will hinder your success. 6. Streamline Your Route With a Strong Sales Team A sales force that can market your company and represent your team to prospective clients is an important component for both short-term and long-term business building. Some pharmacies opt for inside sales teams while others build an outside sales staff. And a hybrid version, with some inside sales staff augmented by external support, is also an option. The type of sales structure you choose depends on your specific needs. INSIDE SALES + extensive geographic coverage + more accounts served compared to other models + less expensive to retain and can yield results equal to that of other models OUTSIDE SALES Choose the sales structure that fits your specific needs. + quick development of strong in-person relationships + more readily able to assist in the PA process + most costly sales model INSIDE/OUTSIDE HYBRID + most effective sales results + compensation plans must encourage cooperation 4

6 7. Train Your Staff to Ensure You Arrive at Your Destination For every aspect of the specialty pharmacy industry, training and continuing education opportunities abound. For example, software providers offer instruction for the implementation and ongoing usage of their SPP-specific applications, and training for other staff, from operations, to clinical to sales, is available and can be tailored specifically to your needs. Accreditation instills confidence and makes your business more marketable. Invest in training, so your staff is empowered. 8. Keep Your Journey Going with Accreditation Accreditation by a governing body in the industry establishes a standard of care for patients, so accreditation signifies to payers and drug manufacturers that your business is capable of providing care according to the standards. Accreditation instills confidence and makes your business more marketable. Currently, four accrediting bodies exist Accreditation Commission for Health Care (ACHC); American Accreditation HealthCare Commission, Inc., also known as URAC; Center for Pharmacy Practice Accreditation (CPPA); and Joint Commission. To determine which accreditation you should seek first, consult the payers in your market, and seek their preferred accreditation. + ACHC is patient focused and a great first accreditation + URAC is currently the preferred standard among many payers + Joint Commission is the most well known and established + CPPA is relatively new but likely to be more in line with health system standards In most cases, depending on which certification you choose, getting accredited can take from 6 months to 2 years. 5

7 9. Continue Beyond Your Original Destination with Consistently Excellent Service References 1 EMD Serono Specialty Digest, 10 th Edition; To ensure that your specialty pharmacy is among those with which patients, prescribers, payers and other stakeholders are satisfied, you have to learn what they want and need and then customize your service to consistently meet those needs. You also have to: be able to adjust to accommodate increases in demand prove that you care about those you are serving demonstrate that you are committed to patient care ensure that you and your employees serve above and beyond the basic minimum standard of care continue to develop and nurture relationships to build your business pick the right partners to ensure your success! Mediware software solutions can work for your specialty pharmacy. Learn more. Mediware is the leading expert in software solutions for specialty pharmacies. Our applications can help manage workflows, track inventories in real time, gain access to hard-to-fill specialty drugs and much more. For information about customized solutions for your business, go to Get expert advice from Specialty Consultants at CSI Specialty Group today. Learn more. Our thanks to Suzette DiMascio, CHE, CMCE, CPC, President/CEO of CSI Specialty Group, for assistance in developing this white paper. Ms. DiMascio is a globally recognized thought leader and strategist for the Specialty Pharmacy Industry. Her company, CSI Specialty Group, is the industry s most influential leader in Specialty Pharmacy Consulting and Talent Acquisition. For additional information, call or go to Mediware Information Systems, Inc West 79th St., Lenexa, KS Mediware