Below is a teaser from our recent podcast with Kevin Colgan, Associate Vice President of Specialty Pharmacy, University HealthSystem Consortium (UHC)
Can you tell us a little bit about UHC?
Kevin: UHC is a consortium of 120 academic medical centers across the United States. We provide those members with many different services. We provide them with benchmarking services, group purchasing services through our supply chain program and we also supply them with specialty pharmacy services.
There’s a lot of interest among hospitals and health systems in establishing their own specialty pharmacies and one of the obvious reasons is the revenue opportunities. Can you talk a little about what the revenue implications are for these organizations?
Kevin: I was one of those who started a specialty pharmacy a few months ago (at Rush University Medical Center) before I started my current position at UHC. I think if you look at it from a macro perspective, you see that by the year 2020, we’re looking at 50% of total US drug expenditures being consumed by specialty pharmaceuticals for just 3-4% of the population. If we just look back at the last 20 months where we’ve had 52 new molecular entities approved by the FDA, we would find that 21 of those are specialty pharmaceuticals. If we look just at oncolytics, we’d see the lowest cost drug is $5500 a month and the highest cost drug is $13,200 a month. The point is that anytime you have this high of cost with a drug therapy, you’re going to have revenue opportunities and implications. So, I think that’s an important piece.
I think the other important piece is that, still, many of these drugs are infusion therapies. If you look at an ACO model, you’re at risk for those Medicare Part B infusion therapies. So, you are not only looking at revenue, but you’re also managing risk.You have to manage risk by following evidence-based guidelines and ultimately doing what’s in the best interest of the patient.
I think the biggest incentive for hospitals, though, goes beyond all the additional revenue. It’s, frankly, just about improving care and the cost of care.
One of the big issues we have with current systems is fragmented care. I recently had a patient who, when her plan changed over, found that her co-pay for Humira was $1100. She couldn’t afford it, quit taking her therapy for three months and started having breakthrough symptoms. We found – even though we weren’t filling the prescription – that we could apply a co-pay assistance card. We worked with her specialty pharmacy and did that so she could afford her prescription.
So, again, fragmented care is a big problem. We have patients that, in an ACO environment, will be hospitalized if they aren’t taken care of under one roof. So, we see that as the overwhelming reason to move forward with the specialty pharmacy initiative at UHC.