Operational Challenges for Specialty Pharmacies

Haley Burgess, SVP of provider surveillance and safety at Inovalon, discussed the operational challenges in specialty pharmacies, including high costs, complex prior authorization processes, and medication adherence issues. Burgess highlighted the role of Inovalon’s platforms, Script Med and Vigilance, in streamlining workflows, improving patient care, and enhancing pharmacist productivity by 50%. Burgess emphasized the importance of data integration, AI-driven tools, and precision medicine in evolving the role of specialty pharmacists.

A transcript of her conversation with Pharmaceutical Executive can be found below.

Pharmaceutical Executive: What do you see as the most pressing operational challenges today for specialty pharmacies?
Haley Burgess: Absolutely, and just a bit about specialty pharmacy. If you think about the growth in this area, it's absolutely exploding. $200 billion in 2024 so a very costly segment of medication and drug spend, and that trajectory is only growing, 70% of new medications in the pipeline are specialty medications. So think your biologics, rare diseases, infusion type medications, and our pharmacists and physicians are rapidly learning about these medications, right? Many of them are new to the market. So, I think there are many challenges in the specialty space. Access comes to mind of just medication access. If you think about the price or the cost, we're running $75,000 per month per drug. It's extremely expensive, and if you think about the prior authorization process by which we are putting patients through with their insurance, it's a real challenge. So for a specialty pharmacist, one collecting all of that rich information from disparate systems so on average, you're looking at four digital systems of different information to make a clinical decision about a patient, and how do you pull all of that information into one place so you can make really good decisions at that point of care, as the patient's calling in, I'd like to get a refill, or I need, you know, my medication. One, has it been approved? Do they have the right access? Are they having adverse events? How do you track that? And where is this information stored? So you can assure that these patients are getting the right information with the right drug at the right time.