Expanding Access for Specialty Medications

By: Melissa Hegna-Wilson

Read time: 6 minutes

As specialty pharmacy continues to expand in the health care space, health systems are looking to partner with a company that can help them be part of a high-performing specialty pharmacy network to deliver medications across care settings. Specialty networks align with payor total cost of care initiatives to allow providers and members access to provider solutions that support continuity of care throughout the healthcare ecosystem.

Partnering for Success

Although each PBM and health plan is different, there are challenges to formulary management and applying indication-based formulary coverage in select classes. In many cases, a member’s medication access is reliant on the PBM that their health plan has chosen. McKesson meets members’ access needs by bridging the gaps in specialty care.

To create a successful environment, it’s important to find a way to partner differently, while complimenting the PBM or health plan.

To create a successful environment, it’s important to find a way to partner differently, while complimenting the PBM or health plan.

In the complex specialty environment, alignment between PBMs and health plans are more important than ever before. This opportunity expands the contracting ability of pharmacies to dispense specialty medications and support patients with rare and complex diseases. This includes hospitals and health systems, independent pharmacies, alternate site pharmacies, and physician practice groups.

Identifying the Gaps in Care

Specialty providers and health systems can reduce cost by bridging the gaps in care, including enhancing prescription capture to target overall patient care.

Ultimately, expanding access to specialty medication should offer resources to help:

• Provide access to care that is patient-focused
• Lower total cost of care for providers, patients, and payers
• Support patient adherence to treatment plan
• Lower medication and hospitalization costs
• Improve patient outcomes

Continuity of Care

There are different restrictions that can potentially cause disruption in filling a prescription, which in turn can cause a delay in care for the patient and prolong the continuity of care. This not only affects a patient’s treatment plan, but it also ties to their mental state and overall well-being. In fact, behavioral health is becoming a larger component of the continuity of care.

In oncology, patients recently diagnosed may be assessed through a population health management team of nurses who will perform immediate outreach to see how they can offer support to those patients and their families.

True continuity of care should be focused on the overall well-being of the patient—not just physically, but also mentally and emotionally.

True continuity of care should be focused on the overall well-being of the patient—not just physically, but also mentally and emotionally.

To achieve this, patients should have access to:

• Affordable medication
• The appropriate provider
• The opportunity to connect mentally and emotionally with the care being provided

Recently there has been an effort to tie adherence metrics with the treatment plan. As long as the continuity of care contains the appropriate criteria according to the patient’s treatment, it’s considered better managed, more complete care.

Welcome to McKesson Specialty Network

To help navigate the complex specialty marketplace and solve for gaps in the healthcare ecosystem, McKesson has created Atlas Specialty—a new specialty-focused pharmacy services administrative organization (PSAO).

Atlas Specialty will drive operational standardization and value for health system members through network access, centralization of contracting, DIR management, and operational efficiencies. For health systems needing assistance with specialty network access, strategic partnerships, and contract standardization, Atlas Specialty is the solution that will help increase specialty prescription capture and decrease specialty script leakage, leading to better continuity of care outcomes and improved financial metrics.

Bringing Care Closer to Home

Partnering with Atlas Specialty also gives health system patients expanded access to care that can be more patient outcome focused.

Other benefits include:

• Help with competitive reimbursements and reduced DIR fees
• Lower total cost of care for both providers, patients, and payers
• Improving quality of care
• Increase continuity of care through inclusion within specialty networks
• Faster speed to therapy time & adherence to treatment plan

Atlas Specialty’s strategic relationships with payors can help health systems spend less time spent on administrative tasks, so they can focus what’s most important—patient health.

Melissa Hegna-Wilson

VP of Specialty Contracting and Payor Engagement

 

Melissa Hegna-Wilson, VP of Specialty Contracting and Payor Engagement, is responsible for McKesson Specialty Network, specifically Atlas Specialty and Biologics.

Melissa has a diverse background with pharmacy benefit managers, health plans, specialty pharmacy, and home infusions, including over 25 years in leadership and operational oversight. Melissa has managed several teams and created new healthcare strategies with executives in various health plans and hospital systems. She has also worked with numerous private equity firms investing in infusion/specialty and has held a number of positions in the managed care space responsible for network development and strategic partnership for specialty providers. In addition, Melissa has been responsible for building and maintaining relationships with health plans regarding home infusion and specialty services, including negotiation of contracts, new business ideas, strategy development, and growth in the market. Melissa holds a bachelor’s degree in Healthcare Administration from Concordia University.

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