Friday, October 17, 2014

Closing Gaps in Specialty Pharmacy Performance

Today’s guest post comes from Stephen C. Vogt, Pharm.D., President and CEO of BioPlus Specialty Pharmacy.

Dr. Vogt offers a thoughtful perspective on specialty pharmacies' shortfalls in managing patients with hepatitis C virus (HCV) infection. He then describes the BioPlus RxSteward™ drug management program, which uses real-time patient data to reduce unnecessary drug utilization while maintaining excellent clinical outcomes. Dr. Vogt also shares data on the program's substantial cost savings. He sees RxSteward™ transforming BioPlus from a dispenser to a partner in a patient's pharmaceutical care.

Read on for details, including a look at drug-cost savings by HCV drug regimen and HCV genotype. Please contact BioPlus for more information about RxSteward™.

Closing Gaps in Specialty Pharmacy Performance: How BioPlus’s RxSteward™ Makes a Difference in HCV Drug Management
by Stephen C. Vogt, Pharm.D., President and CEO, BioPlus Specialty Pharmacy

As Drug Channels reported earlier this year, health plans are largely dissatisfied with the clinical/utilization and reporting services of specialty pharmacy providers (SPPs). In the latest EMD Serono Specialty Digest, fewer than 50% of SPPs earned satisfaction scores higher than 3 (out of 5) from health plans, indicating major gaps in performance.

Specialty pharmacies must close these gaps by moving away from outdated dispensary models and becoming interventional partners in pharmaceutical care. Nowhere are the stakes higher for patients, providers, and health plans than drug management for hepatitis C virus (HCV) infection. Healthcare costs for HCV-related morbidity now exceed $15 billion per year. New antivirals such as Sovaldi (sofosbuvir; SOF), Olysio (simeprevir; SIM), and Harvoni (SOF/ledipasvir) offer the probability of a cure, but high drug costs have fueled considerable controversy.

The Specialty Digest summarized data on specialty drug management programs from 91 health plans covering 124.9 million lives. Using HCV drug management as an example, we will focus on opportunities to improve metrics in three key areas that health plans found lacking: ensuring appropriate dosing, documenting cost savings, and tracking medication discontinuation.


Barely more than half (55%) of all health plans were satisfied with SPPs’ performance related to ensuring the appropriate dose of medication. How can this be improved?

RxSteward™ is an innovative HCV drug management program that reduces unnecessary drug utilization while maintaining excellent clinical outcomes. Using real-time data analysis to compare drug orders against the latest American Association for the Study of Liver Diseases (AASLD) guidelines for HCV management, the RxSteward™ program intervenes to correct the full spectrum of medication errors: contraindication; drug allergy; inappropriate indication; incomplete prescription; incomplete regimen; incorrect administration; incorrect drug duration; incorrect drug frequency; wrong dose; and wrong drug.

RxSteward™ recently found that 18% of prior authorizations for HCV therapy did not meet AASLD recommendations and required intervention to ensure guideline adherence. In one sample of interventions (n=410), the most common error was incorrect drug duration (49.2%), a costly mistake that can erode the effectiveness of antiviral therapy. In another sample of interventions (n=295), 71% of interventions detected drug orders for HCV genotype 1 infection that failed to match the AASLD guidelines for the optimal treatment duration.


Health plans consistently gave SPPs low marks for reporting services. In particular, fewer than half of health plans (46%) were satisfied with SPPs’ documentation of drug-cost savings.

Beyond reporting total cost savings, BioPlus provides both real-time and retrospective data analyses to enable careful scrutiny of drug-management performance. Within the RxSteward™ program, BioPlus reports drug-cost savings by HCV drug regimen and HCV genotype.

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Why is detailed reporting important? Prescribers struggle to keep pace with rapidly changing guidelines, leading to orders for inappropriate therapy and/or duration. Consider examples of pegylated interferon (IFN)-ineligible patients with treatment-naïve HCV genotype 1. Shortening the duration of SOF/SIM/ribavirin (RBV) from 24 weeks (as incorrectly prescribed) to 12 weeks (in accordance with AASLD guidelines) reduces drug costs by approximately $184,000. Alternatively, correcting the inappropriate order for SOF/SIM for 12 weeks to the guideline-recommended regimen of SOF/RBV for 12 weeks reduces drug costs by $75,000.

By intervening to correct these errors, SPPs can improve guideline adherence while saving substantial drug costs. The most recent BioPlus analysis of HCV therapy management found that in just four months (March-June 2014), RxSteward™ interventions resulted in a total cost savings of $9.723 million for HCV medications.


In the Specialty Digest, only 33% of health plans were satisfied with SPPs’ ability to track medication discontinuation. Given the intense focus on the cost/benefit balance of SOF, tracking discontinuation rates for SOF regimens is critical. Through the third quarter of 2014, RxSteward™ has monitored 1,250 patients who began any SOF regimen to treat HCV. The discontinuation rates were 3.7% for SOF/SIM (n=268), 6.3% for SOF/IFN/RBV (n=475), and 10.1% for SOF/RBV (n=507). The overall discontinuation rate for all SOF regimens was 7.3%.

The RxSteward™ is competitive with industry standards for SOF discontinuation. The CVS Health Research Institute recently reported an average discontinuation rate of 8.1% among patients taking any SOF regimen (n=1,975).

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Preliminary real-world discontinuation rates for SOF are roughly four-fold higher than those observed in clinical trials. Early discontinuation signifies substantial drug costs for health plans without the expected clinical benefit for patients—an effective cure for HCV. Programs such as RxSteward™ must intervene to minimize discontinuation and improve outcomes. As HCV drug costs continue to rise—Harvoni is priced at $94,500 for a 12-week course—drug management is increasingly vital to protect the cost/benefit balance for patients and health plans.

Watch for an in-depth analysis of RxSteward’s™ clinical, utilization, and reporting metrics related to HCV drug management on the BioPlus website.


  1. Excellent article and timely. When self-funded employers question their Health Plans and PBM's about what does a specialty pharmacy do can be be demonstrated with the likes of Pharmacies such as BioPlus. I like the fact that SPP's must become more than dispensers.

  2. I would be careful with how you are marketing your program with regard to cost savings. These are not true cost savings, but cost avoidance. The plan is not saving any money over the previous years drug spend, but avoiding additional cost through appropriate utilization of new Hep C therapies.

  3. This is a great way to use the EMD Serono Specialty Digest to validate and benchmark a specialty pharmacy's performance. Sometimes I think the payers do not recognize the programs and services that are available from their specialty pharmacies.