April 30, 2022
How One Hospital System Generated Over $50 Million in Revenues With Specialty Pharmacy
The Specialty Pharmacy segment is seeing a lot of interest from hospital systems – one reason is because of the enormous revenue and profit potential it brings.
This one hospital system, was able to grow their specialty pharmacy revenues from nothing, three years ago, to over $50 million dollars per year by strategically focusing on key specialties.
1.Started with Oncology
This was the most logical place to start as the hospital’s oncology practice has 9 physicians and Oncology is the biggest specialty market segment. The specialty pharmacy was able to learn lessons as they gradually rolled out the specialty pharmacy program. They discovered that they needed a financial assistance expert to guide patients and some extra help with drug sourcing.
This business accounts for approximately one-third of all specialty pharmacy revenue.
2.Moved into MS and Geriatric Physicians
The next focus area was MS and Geriatric physicians
The hospital chose MS because there was one specialist that focused exclusively on this condition and the majority of drugs that the physician was prescribing were readily available and not considered ‘limited distribution’
The Geriatric physician group was also a logical step, as the hospital was able to easily receive prior authorization and be reimbursed by Medicare for the prescribed specialty drugs. However, they were struggling with private payer network requirements and found the reimbursement hurdles difficult to meet.
3.Gastroenterology
With 21 physicians within the Gastroenterology group, the specialty pharmacy was ready take a really big step into the Inflammatory and Hep-C specialty drug market. With the availability of drugs like Enbrel and Humira, as well as the recent launches of Sovaldi and Harvoni, this was an enormous opportunity for the specialty pharmacy.
This group has taken about a year to get on board, with the specialty pharmacy choosing to take on each condition individually (starting with Crohn’s Disease) before moving into Hep C.
The pharmacy has dedicated the next 12-24 months to growing into the Dermatology and Allergy groups and are excited by what these, as well as other specialists will help them achieve.
