Matthew Malachowski of the University of Alabama at Birmingham (UAB) Health System readily acknowledged on Tuesday that a large academic medical center such as his has advantages over a community hospital in starting specialty pharmacy services.
For one, a large academic medical center is commonly where companies conduct some of their clinical trials to support new drug applications for specialty medications. Thus it already has institutional knowledge on some of the specialty medications before they get approved by FDA and also has a list of patients appropriate for therapy and in need of it. And experts on the medical team want someone to provide the infrastructure and support that evaporates once the trials stop.
“But, any hospital in the country that has a quality care team, a good clinical service line, a retail shop, and the wherewithal to push through the struggles can do specialty pharmacy,” said Malachowski, Supervisor for Specialty Pharmacy Services, during a December 4 session at ASHP's Midyear Clinical Meeting in Anaheim, Calif.
Definitions for specialty medication abound, he said.
“Our metaphor at UAB is ‘a drug that creates friction between the patient and their treatment.’ So, if it’s expensive, if it’s potentially toxic, if it has a very robust [prior authorization], if it has very narrow therapeutic windows, if it is difficult to afford, if it’s in limited distribution, this is going to create friction.”
Relieving that friction is where pharmacists and pharmacy interventions can have their biggest impact in helping to care for these patients, whose diseases oftentimes manifest as nebulous symptoms, Malachowski said.
“Our role is to remove that friction and get that patient back to feeling what their version of normal might be.”
Hospital-based pharmacies wanting to start specialty pharmacy services should initially consider the “vulnerable patient populations” — such as hepatology and rheumatology — already being treated by the healthcare organization, he said.
UAB Health System, Malachowski said, started providing specialty pharmacy services in 2015. There was one pharmacist, one pharmacy technician, and a computer at the back of the pharmacy.
“Generally you are quilting together [full-time equivalents] and resources in the beginning to get a proof of concept. You’re going to take someone, generally, who has a clinical bend who can help you navigate these patients, and generally someone who’s not scared of the clinic.”
The clinic “is a brave new world,” he explained. There are a lot of technically skilled practitioners at the clinic, a lot of support staff, and an emphasis on volume. “Everyone is trying to do as much as they can as fast as they can, and we also need to do it as safe as we can.”
Willingness of the clinic’s team to work with the pharmacist is one of the biggest determinants of success or failure, Malachowski said.
“At UAB, we are very blessed,” he said. “Our best marketing occurs within the physician lounge.”