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Coordination of care key to controlling cost, quality.

FLINT, Mich. -- There's no silver bullet for addressing the rising costs of specialty drugs, says Atheer Kaddis, Diplomat Pharmacy's senior vice president of business development, sales and industry relations.

Rather, a multipronged approach, including utilization management based on speedy prior authorization, pre-certification and step therapy, especially on the medical side, is called for, he says. And becoming more important is site-of-care optimization, which looks at moving patient care from high-cost to lower-cost sites. An example would be moving therapy from a hospital outpatient setting or physician's office to the home. Other cost-cutting measures include formulary management, care management and competitive pricing.

Explaining how care management translates into savings, Kaddis cites Diplomat's intervention with both patients and prescribers. The idea is to make sure that they have the necessary information to stay on therapy when it's appropriate and to know how to respond to side effects. Then the information is coordinated with payor clients through case management nurses.

"It is more of a coordinated care approach," he says. "At the end of the day, by having that coordination among all the stakeholders--the patient, the prescriber, the health plan and the specialty pharmacy--we can address the quality of care for the patient."

Multiple parties at Diplomat are integral to the coordination. Call center staff members are on the front line working with prescribers and patients. Simultaneously, the company's clinical staff--clinical pharmacists and nurses--are interacting with health plans' case management nurses. And account management staff are dedicated to clients to ensure that the information that's needed by case management nurses is getting to them. They also coordinate all meetings and interactions between Diplomat and health plan staffs.

Further bolstering Diplomat's capabilities was its recent designation as a Preferred Specialty Pharmacy Vendor by the Association for Community Affiliated Plans. ACAP represents 59 health plans covering 13 million lives, as well as Medicaid, Medicare, the Children's Health Insurance Program and other public programs.

"This is new, and we're very excited about it," Kaddis comments. "Eighteen of these plans are also Medicare special needs plans. And 16 of them have long-term Medicaid coverage. We are honored to be named a preferred specialty pharmacy for ACAP, which allows us to more closely interact with ACAP health plans.

"And they're representing to their health plans that, as they look to contract with specialty pharmacies, Diplomat is one that's endorsed by their umbrella organization. We see this as a tremendous value to Diplomat. It allows us to now reach out to these health plans and share with them what our capabilities are and how we can provide value to their members."

One of the attractions of Diplomat for health plans is its provision of services that are similar to medication therapy management for patients with specialty disease states. The company calls the services "drug therapy management" to avoid confusion with medication therapy management, under which pharmacies are paid by Medicare. Nonetheless, the services are very similar to what is being provided under Medicare, says Kaddis.

Diplomat provides drug therapy management without remuneration, because "we see it as part and parcel of our specialty program--as a fundamental part of the dispensing process, " he says. "We also provide all of the outreach and clinical support. That's necessary for specialty drugs, because they are very complex therapies.

"Drug therapy management really goes hand in hand with our dispensing of these high-cost, complex drugs."

Kaddis has served in his current role since July 2012, and as a company director since February 2013.
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Title Annotation:The Diplomat Difference
Publication:Chain Drug Review
Date:Aug 10, 2015
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