Fairview Specialty Pharmacy

Fairview Specialty Pharmacy

Fairview Pharmacy Services, LLC

‘Specialty Drug’ - Definition

• Complex, high cost products that require additional support and are often used to treat chronic conditions.

• Many are biologics, many are injectable.

• UPlan’s Definition:

“Specialty Prescription Drugs” - shall mean those Prescriptions and other pharmaceutical products, services and supplies listed in Exhibit 1.32 and dispensed by Participating Pharmacies for complex, chronic and high-dollar health care conditions to a Member for which coverage is provided pursuant to the terms and conditions of the Health Plan.  Specialty Pharmacy drugs are complex injectable and oral drugs that have very specific manufacturing, storage, and/or dilution requirements. Specialty drugs are used to treat serious or chronic medical conditions such as multiple sclerosis, hemophilia, hepatitis and rheumatoid arthritis.

Typical Specialty Conditions

• Allergic Asthma• Anemia/Neutropenia• Crohn’s Disease • Cystic Fibrosis • Enzyme Replacement Therapy• Growth Hormone• Hepatitis C• Hemophilia• Hereditary Angioedema

• Infertility• Multiple Sclerosis• Oncology• Osteoporosis• PKU• Psoriasis• Psoriatic Arthritis• Pulmonary Hypertension• Rheumatoid Arthritis

Costs of Specialty Therapies

Typical Annual Rx Expense

Disease States Annual Rx ExpenseAnemia/Neutropenia $10,000Crohn’s Disease $20,000Cystic Fibrosis $30,000Growth Deficiency $25,000Hepatitis C $25,000Infertility $2,400Multiple Sclerosis $20,000Oncology up to $50,000+PKU up to $200,000+Psoriasis $20,000Pulmonary Hypertension up to $250,000Rheumatoid Arthritis $20,000

Specialty Drugs

Anemia/Neutropenia Hepatitis C Oral Oncology Psoriasis Procrit Pegasys Gleevec Enbrel

Epogen Peg-Intron Hycamtin Humira

Aranesp Ribavirin Lysodren Amevive

Neupogen Matulane

Neulasta Infertility Nexavar Pulmonary Hypertension

Bravelle Revlimid Revatio

Crohn’s Disease Follistim Sutent Adcirca

Humira Ganrilex Tarceva Letaris

Cimzia Menopur Targretin

Novarel Tasigna

Cystic Fibrosis Repronex Thyalomid PsoriasisPulmozyme Cetrotide Tykerb Enbrel

Tobi Ovridel Votrient Humira

Gonal-F Xeloda Amevive

Growth Hormone Zolinza

Norditroin Multiple Sclerosis Rheumatoid Arthritis

Genotropin Rebif Enbrel

Humatrope Copaxone Osteoporosis Humira

Nutropin Avonex Forteo Kineret

Saizen Betaseron Cimzia

Omnitrope Ampyra Simponi Tev-Tropin Gilenya

Increlex

UPlan Specialty Drug List

• Fairview Specialty Pharmacy and Duluth only:– Growth Hormone

– Hemophilia

– Multiple Sclerosis

– Rheumatoid Arthritis/ Crohn’s/ Psoriasis

– Oral Oncology

– Cystic Fibrosis

– Anemia/ Neutropenia

• Fairview Specialty Pharmacy and Retail Network:– HIV

– Transplant

– Infertility

– Hematology (Lovenox, Arixtra)

• Limited Distribution Products– Fairview Specialty Pharmacy triages to contracted specialty pharmacy (Tri-essent first)

Grace Fill Policy

• UPlan allows members one month grace fill at retail

• Prime sends list of ‘Specialty Only’ drugs filled at retail to Fairview

• Fairview outreach to member– Pro-active call

– Explanation of Specialty Pharmacy benefit

– Transfer prescription to Fairview or eligible Duluth pharmacies

Typical Specialty Pharmacy Services

• Inventory Specialty Products and Ancillary Supplies

• Refill Reminder Phone Calls/Delivery Coordination

• 24-hour Availability

• Free Shipping and Ancillary Supplies

• Temperature-controlled Shipping

Fairview Specialty Pharmacy - Additional Services‘Big Enough Yet Small Enough’

• Personal, Sophisticated Customer Service– All calls answered live by an experienced pharmacy technician

• Patient Financial Advocates (PFA)– Assigned to each specialty patient

• Courier and Pick-up Options– Courier to 18 surrounding counties– Same day delivery if received by 2 PM

• Fertility Pharmacy Network– 15 locations– Decrease waste

• Part of Fairview Health System– Pharmacists part of care team– Access to medical record

Specialty Therapy Management

Goal: Improve patient outcomes

We know:

Specialty therapies improve outcomes

but …

We also know:

Patients do not take medications the way they should, or in the way it was studied to produce published results

Disease specific algorithms enable us to:

• Ensure standards of care are consistently followed

• Monitor therapy to detect and resolve problems

- Identify opportunities for referral to MTM, PFA, Clinic,

Pharmacist

• Pro-actively identify opportunities to keep patients on therapy

• Help patients become better informed about their therapy so they can more actively take charge of it

Therapy Management - Scope

• Therapy timeline – a ‘plan’

- At initiation: Patient assessment and education

‘ Setting the patient up right’

- Ongoing: Scheduled patient monitoring, therapy reviews and patient

reassessment

‘Keeping the patient on course’

• Case management system allows improved documentation and data

capture

• At Initiation: Patient assessment and education – Product education

– Injection training

– Disease specific assessments (e.g., functional level, recent exacerbations, viral loads, genotypes) 

– Individualized letter to patient and healthcare provider

• Ongoing:  Scheduled patient monitoring, therapy reviews and patient reassessment

– Targeted Questions

– Ongoing education and reinforcement

– Compliance assessment

– Side effect management strategies

– Injection technique assessment and re-training

– Depression assessments

– Disease specific assessments

– Interventions

– Individualized letters to patients and healthcare provider

– Referral  to MTM, PFA, or healthcare provider if indicated

• Therapy timeline – a “plan”

• At initiation: Patient assessment and education

• Ongoing: Scheduled patient monitoring, therapy reviews and patient reassessment

- Surveys- Interventions - Side effect management- Individualized letters to patients and physicians- Referrals to MTM

• Documentation