OncologyRx Care Advantage: Specialty Pharmacy

Situation

• Burgeoning drug pipeline of promising, yet expensive, new oncology therapies many of which are considered specialty drugs requiring special handling, fulfillment, and support services for patients self-administering chemotherapy at home
• The Centers for Medicare & Medicaid Services (CMS) Medicare Modernization Act drives development of alternatives to drug dispensing from oncology practices

Obstacles

• Initial service design was conceived around dispensing services for network practices only
• The service could have much broader payer appeal and relevance if offered and packaged to cover the entire oncology network for any given payer
• Historically adversarial relationship with payers combined with potential for perceived threat of the specialty pharmacy by oncology practices created the need for well-articulated offering and value-added service

Actions

• Created broad-based value proposition geared towards payers and employers and the availability of a new specialty oncology fulfillment service and a Medication Therapy Management program
• Designed sales and marketing program, payer reporting package, and payer service metrics in support of pharmacy launch
• Developed and lead service introduction, sale and negotiations to a large national payer

Results

• The specialty pharmacy service launched on schedule touting a deep payer value proposition with sales messaging to support a complex and competitive sale
• Medication Therapy Management program constructed and delivered as part of the service with ongoing enhancements and reporting to illustrate the value