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Specialty pharmacy is another trending topic that the pharmacy industry is constantly discussing, and it’s becoming a more powerful player with each year. Specialty volume has grown to be 40% of the $450 billion pharmaceutical market, compared to 30% of the $318 billion market in 2012. With value-based care, community pharmacies are considering the possibility of branching into more clinical, high-touch practices like specialty medicine. For pharmacists like Amina Abubakar who maintain strong provider relationships in a community in need of specific care, it is worth the extra time, cost, and effort to earn a specialty accreditation.
Amina is based in Charlotte, NC, a large city currently experiencing increased rates of new HIV cases. As a Board Certified HIV Pharmacist, she and her staff at Rx Clinic work with local providers to provide high-touch care for their HIV patients. Pursuing a URAC (Utilization Review Accreditation Commission) accreditation made sense to Amina, but she admits to some initial doubts in the beginning of her journey.
Along with the expected time, effort, and paperwork that specialty demands, the estimated expenses gave Amina some pause. “One of the more intimidating parts of specialty is accreditation because it is so costly, but you can find ways to minimize the costs, such as using your existing technology and building what you’re measuring into your workflow,” she says. When Amina realized her pharmacy would greatly benefit from learning all the capabilities of their management software, she and Huyen Dang (RxClinic’s “specialty pharmacist”) set out to see if PioneerRx could be their greatest asset in the accreditation process.
At this time, URAC requires pharmacies to pass mandatory measures. “One of the measures was identifying drug-drug interactions. With the reports, we were able to search for patients within a certain time period based on the different types of insurance they had because URAC wanted documentation on Medicare, Medicaid, and those types of insurance,” Huyen explains. “PioneerRx gave us the ability to pull the reports and export that information into an excel sheet, and from the excel sheet, we were able to merge the data in order to find what we needed to check and make sure there weren’t any drug-drug interactions for my patients with certain payers.” Amina and Huyen passed all 5 measures and even impressed the URAC representative. “She said that PioneerRx made her experience as an auditor very easy and stress-free because with her previous audits, she was just so bogged down and stressed out,” Huyen describes.
Although Rx Clinic successfully earned its accreditation, Amina acknowledges that she and her team could have been a bit more organized. She would have updated their systems as they went along and made sure everyone on staff was up-to-speed. In fact, she recommends that pharmacists start behaving like specialty pharmacies before accreditation so it becomes a natural approach to care. For those who may not want to venture into the specialty sector, adjusting your focus to a more care-centric workflow can be rewarding. The preparation pushed Amina and her staff to build a strong, structured foundation of improved care and be able to prove it. When Huyen received the results of the audit, she took even more pride in her practice. “We’re not just telling ourselves we’re good; we can see we are doing a great job,” she says. “This accrediting body has confirmed that we’re doing a good job, and we can take this data to our payers.”
Whether you are considering specialty as a means to provide more in-depth care to your community, or you would like your pharmacy’s standards and methods to be noticed by more payers and providers, all pharmacists can benefit from taking the time to fine-tune their processes and learn the full capabilities of their technology.
Are you thinking about pursuing specialty accreditation? See how pharmacists like Amina are leveraging PioneerRx to meet their required standards and measures.