Leveraging Technology to Optimize the Specialty Pharmacy Supply Chain

Specialty pharmacy stands out as a crucial sector of today’s healthcare landscape, delivering specialized therapies to patients with complex medical needs. Yet, despite its importance, the industry faces significant challenges and inefficiencies that threaten to undermine patient care and drive-up medication costs. One of the most pressing issues is the concentration of pharmacy spend, with specialty therapies accounting for 54% of total drug spend, placing a significant financial burden on payers and patients alike.

In the early 2010s, there was an explosion of specialty spend fueled by new drug introductions and expanded indications for existing specialty medications. This rapid growth in specialty pharmacy spend forced change across the industry. The largest pharmacy benefit managers (PBMs) quickly acquired and/or expanded their in-house specialty pharmacy capabilities to effectively manage the shear growth in the space. With an in-house pharmacy in place, the largest PBMs successfully sold plan designs that included exclusive specialty arrangements to its commercial clients. These exclusive specialty arrangements made it mandatory for members to fulfill specialty medications at the PBM-owned specialty pharmacy. Initially, there were advantages to this model, including the consolidation of medication history data and consistent clinical management of members. There was also a pricing advantage for this model versus utilizing an open specialty pharmacy network where members can go to any specialty pharmacy for their specialty medications. 

Fast forward to today, and now we have new entrants to the market that are disrupting the old way of thinking. Data is now captured and consolidated through technology solutions no matter who is the fulfilling specialty pharmacy. By properly managing a curated network of specialty pharmacies, innovative solutions in the market can produce much more aggressive prices to plan sponsors while, at the same time, delivering optimized clinical care for members. Therapeutic classes encompassing specialty medications require close clinical management of members as well as expertise and access to drugs specific to that disease state.

While improvements have been made by forward-thinking innovators, the current system is still not benefitting all parties involved. Patients are stuck managing multiple aspects of their treatment journey, creating hurdles due to lack of education around the prescription process. Pharmacies face operational challenges in filling prescriptions efficiently, resulting in delays. Manufacturers are spending thousands of dollars for every new medication that gets dispensed to make sure the patient gets on the therapy. To address these challenges, we need a holistic approach that goes further than just optimizing the existing processes.

At Waltz, we believe leveraging technology to increase competition and streamline operations across the specialty pharmacy ecosystem is the key to overcoming these challenges. An enhanced specialty marketplace can work alongside the existing structure to allow for a flexible, open network and empower payers to be much more competitive on pricing. Implementing an end-to-end solution for specialty coverage for health plans brings:

1. Lower costs due to more predictable pricing and relationships with network pharmacies and, more importantly, improved healthcare outcomes for members facing life-threatening conditions;
2. Less friction for patients during the prescription-management process due to limiting number of touchpoints while also empowering patients with tools and resources to navigate their treatment journeys more effectively; and
3. Earlier capture of prescriptions upstream from the prior authorization process, minimizing operational issues for pharmacies

Using technology-driven solutions to enable payers to quickly identify the optimal pharmacy is absolutely critical. Delivering the most cost-effective pharmacy will lower the total spend for payers. Utilizing the optimal specialty pharmacy allows for superior patient experience and improves clinical care, which is by far the most important benefit. By focusing on innovative solutions and utilizing partnerships with specialty pharmacies, we can build a more sustainable, efficient, and patient-centric specialty pharmacy solution —one that meets the evolving needs of patients, providers, and payers. The industry is quickly realizing the benefits of this new model and companies like Waltz Health are supercharging this change in the market. The increasing demand for new models is driving a new world order, and our prediction is that the trend will only continue as new therapies come to market.

Want to learn more? Let’s connect! Contact us at www.waltzhealth.com/contact-us to request a product introduction meeting or potential savings analysis.