NOVEMBER 20, 2023
Specialty Pharmacy Partnership Can Be Fertile Ground
Originally published by our sister publication Pharmacy Practice News
By Marcus A. Banks
Patients in Oklahoma receive specialty fertility medications more quickly and at less cost than they did before, thanks to a two-year partnership between OU Health University of Oklahoma Medical Center and Clearway Health, a Boston-based consultancy that helps health systems strengthen their specialty pharmacy offerings.
But before embarking on the fertility initiative, OU Health had to shore up its overall approach to specialty pharmacy. A few key goals were to provide service at the lowest cost, with ongoing concierge-style support that speeds up prior authorizations and efficiently links patients to their pharmacists, noted Jigar Thakkar, PharmD, MBA, MHCDS, FACHE, the chief administrative officer for OU Health.
OU Health was in a unique position to attempt this level of service, thanks to its scope. “It’s the only academic health system in the entire state of Oklahoma,” Dr. Thakkar said at Asembia’s AXS23 Summit, in Las Vegas. It’s also Oklahoma’s only cancer center designated by the National Institutes of Health, and the state’s only freestanding children’s hospital and Level 1 trauma center, often serving rural residents with few other healthcare options, he added.
OU Health also is a safety-net hospital that is part of the federal government’s 340B Drug Pricing Program that enables health entities to offer drugs to patients at discounted rates.
“There’s not too many hospitals across the country that have these ‘onlies’ for the entire state,” Dr. Thakkar said. And yet, as he assumed his role in 2020, the system had less than three weeks’ cash on hand, compared with 100 days of cash on hand for other health systems. The developing COVID-19 pandemic brought additional financial pressures and workforce strains, threatening the viability of the entire enterprise.
Faced with these headwinds, Dr. Thakkar and other OU Health leaders decided to capture more of the specialty pharmacy market within Oklahoma, while simultaneously attempting to improve patients’ experience with these medications. That’s how the partnership with Clearway Health began. The idea was to bring new revenues and patients into OU Health, at an affordable cost for all the new—and current—patients.
“We work alongside hospitals and other healthcare communities to strengthen their specialty pharmacy programs from any stage,” Alex Pham, PharmD, MBA, Clearway Health’s vice president of client services and strategy, told Specialty Pharmacy Continuum.
Clearway Health provides liaisons to help patients identify financial support and learn how to best use their medications, or to arrange consultations with a pharmacist if their medical needs change or they encounter unwelcome or unanticipated side effects.
Helping Hopeful Parents Navigate the Fertility Treatment Maze
Natasha Stamper, PharmD
Many hopeful parents cannot avail themselves of the fertility support offered by OU Health and Clearway Health. That’s where fertility specialist Natasha Stamper, PharmD, comes in. Dr. Stamper, the founder of Fertility Pharmacist LLC, in Lewiston, Idaho, coaches clients about ways to afford medications and how to store them properly.
Dr. Stamper often works with employers who provide health insurance for fertility treatments to help them defray the high costs of this care. Done correctly, the benefit to patients can be significant. In fact, “some of my clients will actually work at Starbucks just for their fertility insurance coverage,” Dr. Stamper said.
Navigating fertility coverage can be daunting, she stressed. Although many medical insurance plans cover oral fertility medications such as clomiphene or letrozole, fewer plans cover intrauterine insemination and even fewer pay for in vitro fertilization (IVF) or follicle-stimulating hormones such as follitropin alfa (Gonal-F, EMD Serono), Dr. Stamper noted. IVF often requires egg freezing, which can cost up to $5,000 per freezing cycle, she said. Anyone who must pay for IVF treatments or follitropin alfa out of pocket can sometimes access rebate plans based on income, or discounts for veterans if those apply, or they can cold-call different specialty pharmacies to see who will provide a treatment for the best price. But wading through these options can be time-consuming.
“I wish there was one application people could use to apply for everything related to fertility, but unfortunately that doesn’t exist,” Dr. Stamper said, which is why she points clients to financial resources that she discovered herself when aiming to conceive with IVF in 2014. Compared with that time, Dr. Stamper said, today social media sites such as Instagram and TikTok make it easier to share this information.
Once they’re paid for, fertility medications have specific storage requirements. Dr. Stamper noted that some medications must be refrigerated, others must be shielded from light and any injections must be handled carefully due to the risks of sharp needles. A woman trying to conceive may need medications in each of these categories, Dr. Stamper said, making appropriate storage and handling critical.
“My goal is that all my clients know how to use their medications safely. And we certainly don’t want any medication to spoil because it wasn’t in the refrigerator,” Dr. Stamper said, adding that this would be a tragic outcome after working so hard to get the treatments in the first place.
“I think the cost of medication is what stops many people from pursuing fertility treatment,” Dr. Stamper said.
Dr. Stamper reported no relevant financial disclosures beyond her stated employment.
“Specialty drugs are very expensive and really well controlled by the payor market,” Dr. Pham said, realities that sometimes prevent patients from starting treatment. Clearway Health’s definition of “specialty” means any drug that requires “extensive monitoring and handling,” Dr. Pham noted. Although this strategy would encompass extremely expensive drugs for rare diseases, less expensive but still non-standard drugs and services also fit within this rubric if they have the potential for incurring extensive healthcare costs when misused. Interventions that may help patients avoid hospitalizations also fit this model, he noted. As a result, “our definition of specialty medications is pretty dynamic,” Dr. Pham said.
A Fertility Framework
Fertility medications, which may not be as pricey as gene therapies but are nonetheless costly and complicated to use, fit Clearway Health’s specialty medications framework. And the need is certainly there. According to 2023 statistics from the World Health Organization, one in six people experience infertility—the inability to conceive after 12 months of unprotected sexual intercourse—worldwide.
At OU Health, the Clearway Health partnership saved patients $410,205 in fertility medication costs over five months, Drs. Thakkar and Pham reported. These medications often aren’t covered by insurance. The savings were due to OU Health’s 340B status along with liaison support to help expectant parents apply for financial assistance programs that reduce the costs of fertility treatments. For example, an OU Health patient on a fixed income received in vitro fertilization for $400 per treatment thanks to such programs, rather than the initial $2,400 charge.
The Clearway Health and OU Health partnership is able to secure prior authorization approval in less than a day while one estimate of the industry standard is at least two and as much as 31 days, Drs. Thakkar and Pham reported. The partnership also secured $995,000 in patient assistance funds from July 2022-2023.
In addition, more than 2,000 prescriptions per month are mailed at no charge to patients who need them. Much of this is funded through new specialty pharmacy revenues; prior to the Clearway Health partnership only 8% of OU Health patients received specialty pharmacy services, whereas 45% do today.
OU Health’s next steps, again partnering with Clearway Health, are to research whether these initiatives reduce overall healthcare spending by improving patient outcomes.
“As you’re thinking about your specialty program, it’s about much more than capturing scripts,” Dr. Thakkar said. “It’s truly about transforming your clinical care model.”