Bringing Local Pharmacies to the Specialty Table

Rinku Patel, PharmD, spent most of her career working in large pharmacy organizations. But in 2011, after more than 10 years in leadership roles with Walgreens, CVS Caremark, Option Care and Diplomat Specialty Pharmacy, Dr. Patel decided it was time for a change—not just for herself, but for specialty pharmacy itself.

“When specialty was first coming into existence, it was more of a high-touch, face-to-face model where a pharmacist provided more direct support to the patient. But as the industry grew and more and more specialty drugs were approved in the market, more control was imposed by payors and the pharmaceutical industry to manage the growing trend. The net result was that the service model for the patient changed,” Dr. Patel said.

“From high touch, we went to more of a high-tech model, with mail-order specialty pharmacies shipping drugs across the country and caring for patients over the phone and via the internet through patient portals.”

In addition, those same patients are typically going to a local retail pharmacy for acute medications, like antibiotics or over-the-counter drugs, and dealing with yet another mail-order pharmacy for ongoing chronic disease nonspecialty medications, such as those for hypertension or diabetes.

“They’re usually incentivized by the payor or the PBM [pharmacy benefits manager] to use the 90-day mail-order model for these drugs, but it’s not feasible for specialty pharmacies to ship acute medications or nonspecialty maintenance medications, due to low profitability and payor network arrangements,” Dr. Patel noted. “Even if the same pharmacy organization offered all three points of care, they are not connected. We’re left with a fragmented patient experience and the problem of polypharmacy.”

A Better Way

Dr. Patel decided that there had to be a better way. After considerable market research, she found that independently owned and operated community pharmacies have better relationships with their patients than larger chain counterparts, but because of a lack of infrastructure, expertise and economies of scale, they can’t provide a one-pharmacy “home” for those patients.

But what if someone else could? That was the germ of an idea that led her to create KloudScript (KS), a specialty-at-retail company that provides a turnkey solution for the infrastructure and capabilities typically found in large specialty operations to independent, locally owned pharmacies.

Founded in 2013, KS now has more than 500 pharmacy partners in 45 states, and Dr. Patel projects that the company will be in all 50 states in the next few months.

The company currently services multiple specialty therapy areas: behavioral health, Crohn’s disease, hepatitis C virus (HCV), HIV, multiple sclerosis, oncology, osteoporosis, psoriasis, rheumatoid arthritis and ulcerative colitis. Dr. Patel said the roster of diseases is also likely to grow.

Through a cloud-based patient care management technology platform called KETU, KloudScript provides the lion’s share of the back-office processes for its independent retail pharmacy partners: training and education in specialty, sales and marketing strategy, full-service hub support, strategic business development with payors and pharma, and prescription and patient care management.

The independent pharmacy, for its part, focuses on what it does best: dispensing medications and providing hands-on, individualized patient care.

In mid-October, KS hit a milestone: In partnership with Illinois-based Doc’s Pharmacy, it was accredited by the Center for Pharmacy Practice Accreditation (CPPA).

“This is a unique model of specialty pharmacy care,” said Lynnae Mahaney, BSPharm, MBA, FASHP, CPPA’s executive director. “There are hub services out there, and KloudScript does serve as a hub provider, doing prior authorization and benefits investigations, and aggregating data from the pharmacy practices. But what’s unique is that KloudScript oversees the quality of care delivered by their partner pharmacies. Their pharmacies utilize the KS software platform, and the pharmacist must be trained on and follow the KS patient care protocols. This ensures consistency of patient care while enabling specialty pharmacy to have a very local flavor.”

The “partnership” accreditation is new for CPPA, Ms. Mahaney said, but it illustrates CPPA’s philosophy. “We knew our accreditation program needed to be adaptable to these evolving models of specialty pharmacy care. So we’ve consciously made sure our standards and our accreditation program could be flexible to fit these models.”

Accreditation a Team Effort

KloudScript also facilitates and manages the accreditation process for each of its partners that want to attain CPPA accreditation. Neither KS nor Doc’s—or any other pharmacy partner—could achieve accreditation independently, Ms. Mahaney said. “We reviewed all our standards to determine which organization, KS or the partner pharmacy, is responsible for what standards—the elements that KloudScript is doing and those that the pharmacy is performing. In some cases, there is overlap, standards for which they are both responsible.”

Gateway to Accreditation

The family-owned Gateway Health Mart Pharmacy, which has four locations in Bismarck and Mandan, N.D., is now in the process of becoming CPPA-accredited as a specialty pharmacy through its KS partnership. Since Gateway rolled out its specialty program with KS in October 2015, Vice President Briana Fluhrer, PharmD, estimated that the pharmacy’s specialty book of business has grown by nearly 75%.

“Previous to that, the only specialty we were doing was filling some walk-in prescriptions and our regular patients’ specialty prescriptions. Now, we are seeing a whole host of new [specialty] patients that we never were previously filling for,” she said.

Gateway’s leading specialty areas are autoimmune, with a large share of psoriasis, irritable bowel syndrome, Crohn’s disease and ulcerative colitis; they also serve a number of patients with HCV and HIV.

“We do some oncology but not a lot, because much of oncology in this area is IV, and the oral drugs are often limited distribution,” Dr. Fluhrer said. “Once we are accredited by CPPA, we hope that it will lead some of the manufacturers to see us as a true specialty pharmacy and allow us access to limited distribution drugs.”

Gateway could not have broken into the specialty market in a real way on its own, according to Dr. Fluhrer. “We really benefit from their overall knowledge of the industry: benefits investigations, the ins and outs of foundation support for patients who might not meet the criteria for copay assistance and a wealth of knowledge about the clinical aspects of all the drugs as well. And as payors continue to require us to have more and more documentation, they’re always updating their software platform to reflect that.”

—Gina Shaw