This blog is the third installment of a five-part series on Navigating Your Entry Into Specialty Pharmacy and serves as a step-by-step guide for integrated healthcare systems.
Steps to Develop Your Business Case to the C-Suite
There are some levels of the C-Suite that buy into the idea of a specialty pharmacy. However, the ones that are on the other side of the checkbook may not have been exposed to what is happening in the specialty pharmacy industry.
What Questions Should You Ask Yourself?
It is important to give some thought to what questions you should be asking yourself in order to put your pro forma together. This will help your executives make a concise decision on whether or not specialty pharmacy is right for you.
Make sure you have the answers to these questions:
- Are you self-insured?
- What is the market potential in my geographical area?
- How will this affect your employees?
- Do you have the infrastructure necessary?
- Do you have enough employees today that could be trained and leveraged to run your specialty pharmacy?
Are you Self-Insured?
One of the first things that you should consider is if you are self-insured or not. Self-insured hospital systems have the opportunity to take care of their own employees first. It starts with looking at your own patients and identifying the number of scripts that are specific to specialty and how much is being spent on specialty drugs.
This gets even more interesting with for a 340B (a drug discount program providing outpatient drugs to eligible health care organizations/covered entities at significantly reduced prices), which we will discuss in-depth later.
Market Potential in My Area
As you start painting the picture of your specialty pharmacy, it is important to identify if the market exists and how big the growth potential is. One thing that every executive asks:
“What is the market potential in our area?”
The answer really depends on each hospital system’s individual situation.
You need to evaluate to see if the market potential is there for you. Human resources (HR) is not always a partner with the pharmacy. A lack of any real relationship with HR can make it difficult for you to get the information you need to make decisions. Make sure the teams are as frictionless as possible. You will also want to access information from your pharmacy benefit manager (PBM) to evaluate your spend.
How Will This Affect Your Employees?
Another thing that you will want to consider is what difference it will make in an employee’s life by having their specialty pharmacy needs handled by their own hospital.
Generally, it is easier and more convenient for employees since they are insured under your plan. This service can also aid in attracting talent, too
Another plus, if an employee is not feeling well or needs a new prescription, they can pick up their medication right where they work… which is something not many people can say.
Do You Have the Infrastructure Necessary?
The next thing to consider as you build your case to bring to your C-Suite is your infrastructure. Some hospital systems are fortunate enough to already have space not being utilized they can allocate to their specialty pharmacy. However, you may be wondering if you need a standalone specialty pharmacy and how much space you need.
As stated before, specialty pharmacy is not a “one size fits all” solution, so there is no clearcut answer to whether you will need a standalone space or not. It will all depend on the size of your specialty pharmacy and your goals for growth.
Keep in mind you don’t have to start with a very large facility, either. You can grow into a facility as the business organically grows. Do not think you have to open up a 25,000-square-foot specialty pharmacy just to compete in the marketplace.
Do You Have Enough Employees Today that Could be Trained and Leveraged to Run Your Specialty Pharmacy?
The last thing you want to consider is your full-time equivalent (FTE) support. Do you have enough employees today that could be trained and leveraged to run your specialty pharmacy tomorrow?
It is important to attract the right talent, train them and develop an overview of when the specialty pharmacy is launched that will take place from an employee’s perspective.
Certified pharmacy technicians will end up being your biggest employment segment. Pharmacy technicians currently working in various locations that serve the community may need to be retained. This requires you to evaluate shift scheduling, which will vary depending on your health system’s size and regional footprint.
It may be necessary to add new hires, but that number is typically small (especially at the outset). Many hospital systems can shift their resources as needed. For example, an employee may be a technician one day and a patient care coordinator another. They can set up orders, take calls and do data entry in a variety of work in the specialty pharmacy industry.
It is also important to allow developmental growth for your employees. A vast majority of workers will need an opportunity, channel and/or incentive to develop their skills in specialty pharmacy. This is especially true because specialty pharmacy patients are often more complex and disease states are high-touch when compared to your typical community pharmacy. There are many advantages for the associates and the hospital.
This gives employees another opportunity for growth. You may be able to work with your HR department to get a pharmacy technician I, pharmacy technician II, pharmacy technician III and so on. This creates a ladder of progression so the technicians can ascend within your organization.
Let’s recap the steps recommended to take when attempting to build your business case to your C-Suite.
- Ideally, you want to be able to start with your employees
- If you’re self-insured evaluate your information and drug spend
- Go to your HR department and get some information on your specialty spend
- Develop a strategic relationship with your HR department
- Retrain and repurpose current employees with a growth perspective within your organization
- Evaluate whether you have an infrastructure that you can utilize today and what will it do in five and 10 years as you develop your projections
- Know the industry
- Know the facts where specialty pharmacy is growing
- Know your strengths
- How are you going to get access to limited distribution drugs and payer contracts
When you start slow with your employees first and build upon your excellence, you’ll be very successful in the specialty pharmacy industry. CSI Specialty Group is always here to help you in your journey!