How the health system is thriving in navigating professional pharmacy landscapes

Demand for specialty medications is rising as people with complex health conditions increasingly rely on new treatments and therapies to manage their health. By working with consulting services, health systems can leverage established expertise to assess and select potential solutions to operate and optimize integrated specialist pharmacies.

In 2023, nearly 6% of the population is using specialty drug therapies, compared with 5.3% a few years ago. Specialty drug therapy presents challenges to health systems because specialty drugs require unique treatments, such as temperature control and monitoring requirements, and their effectiveness depends on patients who adhere to sometimes complex treatment plans. Despite these challenges, the increase in health systems’ investment in professional pharmacy programs is largely due to the patient benefits of integrated professional pharmacy programs.

Health system specialty pharmacies have been found to improve drug disorders, enhance compliance with treatment plans, and ultimately provide patients with better outcomes. By bringing professional pharmacies to their portfolio, the health system can provide high exposure support throughout the patient’s care process. Due to their close contact with patients, the location of integrated professional pharmacists is a unique position among addressing patient concerns and potential financial barriers, promoting patient education, and coordinating nursing teams, which can reduce stress on patients and improve their ability to adhere to special drug treatment options.

Patient victory is a victory for the health system, making it clear that integrated professional pharmacies are a key strategy for the health system as they aim to provide the best care for the patients they serve. This is why the prevalence of professional pharmacies in health systems has increased significantly in recent years, with as many as 90% of large hospitals and health systems operating professional pharmacies in some capacity. While obviously beneficial for patients and overall health systems, operating and optimizing professional pharmacies presents unique challenges that hospitals and health systems should be prepared to address.

Simplify management process

Hospitals and health systems are dedicated to a large number of resources to obtain the highest quality of patient care. This focus, while important, may mean that health systems will become thinner when it comes to management support. Professional pharmacies must meet complex requirements and introduce administrative requirements, which can be challenging for internal management of health systems. To address this challenge, a variety of strategies can be adopted, including the following.

• Centralized prior authorization process: Getting approved drugs can take a lot of time, effort and coordination. By simplifying approvals through a centralized prior authorization process, the time and resources required to obtain approval can be greatly reduced. Health systems can take a step further by establishing standardized workflows to document, minimizing errors and ensuring consistent capture of necessary information.

• Implement the correct tool: Health systems should always look for new tools and technologies that can help them simplify and expand professional pharmacy operations. Some tools have built up good revenue cycle management systems, while others are constantly creating and innovating, such as AI tools that can identify patients who may be at risk of non-compliance. Leading health systems are beginning to go beyond basic tools and use integrated platforms that combine clinical documentation, predictive analytics and welfare verification to automate their professional pharmacy operations and reduce the need to copy documents.

• Develop a contingency plan: The professional pharmacy landscape is constantly evolving, and with changes in regulatory policies, it has brought obstacles to the health system. By staying informed and developing contingency plans around potential challenges, health systems can adapt to relevant regulatory shifts with minimal impact on their operations.

Embrace cooperation

Professional pharmacy growth can be resource-intensive. Towards optimizing, sustainable growth, health systems should consider strategic partnerships and work with industry experts to help fill any gaps. Taking advantage of consulting services provided by distributors, joining the Pharmaceutical Services Administrative Organization (PSAOS), and working with experienced consultants are potential strategies that can help health systems improve their professional pharmacy programs.

Health systems can work with strategic partners to optimize their specialized pharmacy operations in multiple areas of research and implementation of new technologies, as well as aligning with the latest regulatory shifts and recommend new patient engagement strategies. External expertise can be an important advantage for hospitals and health systems and can be viewed in complex professional pharmacy landscapes.

Drive sustainable growth

Specialty pharmacies are expected to continue to be popular in the coming years due to the increasing demand for complex therapies due to the diagnosis of complex medical conditions. Integrating specialist pharmacies into health systems is a strategic initiative that supports sustainable growth and improves patient outcomes. By addressing the unique challenges of operating a professional pharmacy, the health system can create an effective service model that enhances patient care while thriving the health system.

Photo: Bluebay2014, Getty Images

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