Patients diagnosed with serious disease have enough on their minds. So Walgreens is doing all it can to make it easier for them to obtain, administer and pay for their specialty and infused medicines, said Mike Ellis, VP specialty pharmacy and infusion.
“The concept is to go where patients are diagnosed and where they reside. We have a large sales force who call on physicians who prescribe these types of medications. But like everything else at Walgreens, it starts with the patient.”
“Our strategy in this space is getting the drug where it’s the least costly and the most clinically appropriate site of service that the patient desires,” Ellis explained. “That may be in the home, the physician’s office, the outpatient setting or even the hospital in some cases.”
Ellis, a pharmacist, forged a 30-year career in specialty and infusion medication therapy with Olsten Health Services, Quantum Health Resources, Advance PCS and most recently, CVS Caremark, where he served as SVP specialty trade relations and contracting and pharmaceutical services, before joining Walgreens in September 2011.
The specialty pharmacy business, the industry veteran said, “has transformed Walgreens from just the corner drug store and acute care pharmacy to one with experts in some of the most complicated disease states out there, with the most expensive medicines and the most clinically challenging patients. Walgreens, with its collection of assets, has to be strongly considered as a third healthcare destination beyond the physician’s office and the hospital.”
It may surprise some that Walgreens has become the nation’s third-largest provider of specialty medications and “the largest non-PBM-owned specialty pharmacy,” according to Ellis. The company also is the nation’s largest provider of home infusion services, giving it a powerful voice with manufacturers and the public and private payers who pay for these types of drugs.
“We have four large central specialty pharmacies that can distribute across the country, and almost 100 infusion pharmacies strategically located in local marketplaces, because you need to be in the local marketplace to deliver care,” he said. “We’re also unique in that we employ our own nurses. So in over 92% of the cases we handle, our nurses administer those drugs, as opposed to using contract nurses.”
“We believe, and our data proves, that our quality of care and outcomes are much higher because our nurses have relationships with the patients and are familiar with the drugs,” Ellis asserted.
All those assets give Walgreens distinct competitive advantages in specialty and home infusion, he continued, as well as additional touchpoints with patients across the United States that extend well beyond its 8,000 retail and hospital-based pharmacies and clinics. What’s more, the company’s ability to serve patients with chronic and serious conditions in any setting they choose — be it the home, retail pharmacy, outpatient hospital, physician office, mail or Take Care Clinic through one of its four central specialty pharmacies, its specialty Center of Excellence pharmacies or its traditional community pharmacies — helps build its name recognition, loyalty and new business with patients, prescribing physicians, payers and manufacturers, Ellis said.
“Ninety percent of our infusion patients have never used Walgreens, which is kind of astounding, but many of them have been healthy until they acquired the condition they’re now dealing with. We think that by providing this service, we will create a loyal bond with that patient for many years to come,” he added.
Walgreens’ multichannel approach to specialty and home infusion also can lead to lower health costs for patients and payers, Ellis said. “Because of the skill sets of our clinicians, we don’t necessarily have to put patients in an outpatient setting to achieve the same clinical results. And the cost differences are dramatic.”
“Much depends on getting the patient to the most appropriate clinical site of care,” he added. “Our ability to deliver medications in the home, the pharmacy or in one of our ambulatory treatment centers, versus an outpatient or hospital setting, can mean as much as a 30% to 40% difference in the cost of the drug and the procedure.”
One of Walgreens’ key assets for staking a major claim to the specialty market is the hundreds of pharmacies around the United States that the company has converted to “Centers of Excellence” for a particular disease state. The centers are a key resource for attracting and treating patients with specific serious conditions, such as HIV.
“Can Walgreens have 8,000 stores with more than 27,000 pharmacists trained in all of these disease states? While certainly a goal, that may not be realistic given the low incidences of these types of diseases. So we’ve developed a hub-and-spoke model across the country,” Ellis explained. “For example, we have about 600 Centers of Excellence around HIV, in areas where there’s a high incidence of the disease.”
In a Center of Excellence pharmacy, Ellis said, Walgreens employs “very specific staff trained in that disease state. And that’s very important if you’re afflicted with one of these complex conditions.”
In its pharmacies that specialize in HIV and hepatitis, for instance, “there are social issues that go along with that disease. So the staff undergoes intense clinical and sensitivity training,” he said. Pharmacists and technicians in those stores also get special training to help their patients line up the resources to allay the costs of expensive HIV/AIDS medications, including financial aid and co-pay assistance programs from manufacturers and charitable organizations.
For patients dealing with serious diseases like HIV, the Centers of Excellence provide a convenient, locally accessible option for obtaining specialty medicines and learning about their use and administration, added Jeff Berkowitz, SVP pharmaceutical development and market access. “At retail Center of Excellence, pharmacists can work with patients in ways you can’t with a central-fill specialty pharmacy,” he said. “When that patient comes into our stores and seeks help” with issues like self-injecting drugs or learning about their side effects, “they’ve got that patient-pharmacist relationship.”
Health stakeholders, including the federal government, are beginning to recognize the potential for improved patient outcomes and cost-effective care that the Centers of Excellence provide, Ellis said. The Centers for Disease Control and Prevention has launched a new pilot program with select Walgreens and Take Care Clinic locations where the pharmacist or nurse practitioner are trained to deliver confidential HIV testing and counseling. In another newly announced program, the Department of Health and Human Services is looking to the company to demonstrate the effectiveness of medication therapy management for the HIV population. Ellis said, “To be recognized by the federal government as a leading expert in HIV is pretty special.”