Walgreen's Speciality Pharmacy

Question 1

IQVIA Definition of Speciality Medication

Answer 1

Meets 5 of the 8 critieria:
- Biotech product
- injectable formulation
- REMS
- treats chronic condition
- requires special handling
- specialist-initiated
- costs ≥ 6,000$ per year
- limited distribution

Question 2

Money Spent to Manage Speciality Patients is far beyond ddrug cost

Answer 2

• drug cost
• wasted drugs
• adverse events
• poor adherence
• additional doctor visits

Question 3

Types of Speciality Pharmacies at Walgreens

Answer 3

Centralized Speciality Pharmacies
- mail/ship products
- wide access to limited distribution drugs
- cannot speak to RPh in person

Speciality at Retail –> Hub
- disease state hubs
- RPh is educated on special disease states
- no access to limited distribution drugs

Community-Based
- traditional community pharmacy
- outreach calls & delivery

Question 4

Staffing Requirements

Answer 4

• 2.5 to 3.5 times the normal retail requirements due to complexity
• 70-85% of claims require PA
• > 30% of patients need financial support

Question 5

Step 1: Intake

Answer 5

• most scripts are electronic (e-scrpts) but can be fax or written
• most scripts come directly from the prescriber (specific ways to reach out to offices)

1. Register patient
   - fill in insurance, PMH, medication history
2. Run prescription through & see if they are contracted with insurance
   - if yes, do we have access to drug
   - if no, contact provider to speak about a transfer

MOST CLAIMS REQUIRE PA (70-85%)

Question 6

Step 2: Prior Authorization

Answer 6

• staff is dedicated for PA through “Covermymeds”
• RPh makes sure everything is entered correctly and the right drug for the right person –> sends to provider office
• provider office has the final submission

FOLLOW-UP
- push back to see why it is not approved and next steps

Question 7

Step 3: Financial Assistance

Answer 7

1. Copay cards
   - for commercial-insured patients
   - by manufactuer for brand name products
   - 30 day vouchers
2. Patient Assistance Foundations
   - for patients with insurance
   - by 3rd party websites providing grants
   - income based
3. Patient Assistance Programs (Free Drug)
   - no insurance required
   - by manufacturer or Rx contracted
   - income based through an application

Question 8

Step 4: Patient Counseling

Answer 8

1st ORDER THE MEDICATION

• initial assessment –> update the profile, PMH, discuss storage, administration, miss doses, side effects
• REMS or LDD requirements
• pick delivery/pickup date

Question 9

Step 5: Prescription Delivery

Answer 9

1. REMS Requirements
   - date of delivery & patient signature
2. Storage Requirements
3. Insurance Requirements
   - IN Medicaid requires patient to sign
4. LDD Requirements
   - LOT # & inventory count

Question 10

Step 6: Follow-Up

Answer 10

Adherence & Clinical –> every refill

ADR –> as needed/contracted

Reassessment –> every 6 months

Question 11

WALGREENS WAS THE FIRST TO RECEIVE ENTERPRISE WIDE ACCREDITATION FROM URAC

Answer 11

WALGREENS WAS THE FIRST TO RECEIVE ENTERPRISE WIDE ACCREDITATION FROM URAC

Question 12

Limited Distribution

Answer 12

> 25% of speciality medications are limited distribution

majority of new medications are limited distribution

LDD Requirements
- must report adverse events
- must report how much medication in stock

MANUFACTURER DICTATES WHO HAS ACCESS TO MEDICATIONS