URAC White Paper Highlights the Changing Role of Specialty Pharmacy and Its Impact on Patient Outcomes

Pharmacist and woman discussing medication

WASHINGTON, DC – April 19, 2017 –Independent accreditor URAC today released a new Industry Insight Report for specialty pharmacy providers entitled “Competing in the Specialty Pharmacy Market: Key Competencies for Performance in Value-Based Healthcare.” The report examines why specialty pharmacies need to incorporate a sixth right -- the right result -- to the traditional “five rights” of medication administration, to be successful in the value-based healthcare model. The patient-centric care model, when employed by specialty pharmacies, means working with individual patients and their providers to achieve the drug’s intended therapeutic result and prevent a costly hospital stay.

“Pharmacists and pharmacies have evolved from playing supporting roles to being vital leaders in managing patient care and improving outcomes,” says Kylanne Green, URAC’s president and CEO. 

Achieving the right result is critical for reducing hospital readmissions and keeping healthcare costs low. Nearly 18 percent of Medicare patients are readmitted to the hospital within 30 days of discharge, often because they didn’t follow their medication therapy as prescribed. This year, hospitals will get hit with an average 0.74 percent reduction of Medicare payments for these avoidable readmissions.

Health plans, pharmacy benefit managers (PBMs) and drug manufacturers are therefore seeking to partner only with specialty pharmacies that can demonstrate a proven ability to deliver better care and outcomes at a lower cost.

“The need for managing patient care throughout the course of therapy has never been greater,” Green says. “Pharmacists and pharmacies that position themselves as an essential part of the care team will succeed.”

The specialty drug market continues to grow exponentially. Specialty drugs designed to treat individuals with chronic or genetic diseases and disorders comprise nearly one-third of the pharmacy industry’s revenue and could account for up to 50 percent within three years. The drugs are among the most expensive therapies available. Specialty pharmacists provide unique, hands-on care to help patients manage their side effects, adhere to their drug therapies and obtain resources to help pay for their medications.

“This patient management piece is what distinguishes specialty pharmacies from other pharmacies,” says Green. “It’s no longer just about the drug; it’s about the entire management of the medication process.”

The Industry Insight Report explores the evolving role of specialty pharmacists and their front-seat role in managing patient outcomes, which includes:

  • Working directly with patients to help improve patient adherence to drug therapies
  • Measuring the effectiveness of their processes and tracking it over time to identify areas for improvement
  • Improving operational efficiencies
  • Adhering to clinical best practices
  • Pursuing accreditation by a third-party organization that regularly evaluates their ability to impact medication adherence and medication management.

Specialty pharmacies that embrace these strategies will win the opportunity to improve the lives of patients who require complex drug therapies, including those taking treatments for cancer, multiple sclerosis and/or rheumatoid arthritis.

The report notes that one of the top strategic focus areas among health insurance companies this year is to coordinate specialty drug management across pharmacy and medical benefits.

“The pharmacy market has a significant role to play in creating a more collaborative model of care, particularly in the types of high-touch therapies provided by specialty pharmacies,” says Heather Bonome, PharmD, URAC’s director of pharmacy. “Accredited, patient-centered specialty pharmacies will be best positioned to win some of this business.” 

URAC’s Industry Insight Report, Competing in the Specialty Pharmacy Market: Key Competencies for Performance in Value-Based Healthcare, can be downloaded for free at: https://www.urac.org/publications/competing-specialty-pharmacy-market-achieving-success-value-based-healthcare


About URAC

Founded in 1990, URAC is the independent leader in promoting healthcare quality through accreditation, certification and measurement. URAC offers a wide range of quality benchmarking programs that reflect the latest changes in healthcare and provide a symbol of excellence for organizations to showcase their validated commitment to quality and accountability. URAC’s evidence-based measures and standards are developed through inclusive engagement with a broad range of stakeholders committed to improving the quality of healthcare. For more information, visit urac.org.

Media Contact:
Che Parker, MA 
VP, Sales and Marketing