"Some are born great, some achieve greatness, and some have greatness thrust upon 'em."
Everyone knows the age-old adage about greatness and how it’s thrust upon some. For Morgan Miller, her “greatness” is the specialty program she built from the ground up at Alps Pharmacy in Springfield, Missouri.
Morgan laughs as she looks back on the day Melody Savley, owner of Alps Pharmacy, chose her to oversee the specialty program. “I thought, Whoa, okay, I can do this. But I’m really glad that I did because I really, truly love it.”
Morgan is only four years into her career as a pharmacist, and nearly half of it has been spent researching, planning, and implementing the specialty program. “I always knew the medical field was going to be a good route for me,” she says. “I love independent pharmacy. I think it has a special place in the community. You just get to do so much more for patients than sometimes the red tape that comes with some of the more corporate-type pharmacies.”
The flexibility of independent pharmacy allowed the Alps Pharmacy staff to explore different avenues. With specialty pharmacy projected to make up 50% of overall drug costs over the next few years and Springfield’s demand for hepatitis C relief, this was an opportunity that couldn’t be passed up.
When handed the task of initiating the specialty pharmacy, Morgan did what most of us in the digital age do: she Googled it. In her research, she found example enrollment forms and articles from NCPA and APhA that connected her to other pharmacists who had started their own specialty programs. These colleagues, who were very willing to share their knowledge, advised her to begin building relationships with physicians. “One of the questions I would ask doctors and mostly nurses (because that’s who does the legwork with insurance benefits) is what their biggest frustration or problem is. Constantly, they told me it was communication. They didn’t know what was going on with their prescriptions. Right then, I knew I had the ability to take the time and tailor the experience for the doctor. I already knew we could take excellent care of their patients, but I needed to know how I could take excellent care of them.” Overall, Morgan recommends following the advice your colleagues have to offer and tailoring it to your pharmacy’s own unique needs. “We didn’t reinvent the wheel,” she says. “We just added our own flair to it.”
For those starting out in specialty pharmacy but don’t know where to begin, Morgan recommends picking one to three disease states to focus on first. As tempting as it may be to try to cover a lot of territory at once, choosing to keep your focus limited will help you perfect your processes, knowledge, and entrance formularies for those disease states. She lists hepatitis C, rheumatoid arthritis, and psoriasis as her initial focuses because she already had a large patient base for those. “Don’t overburden yourself,” she advises.
One of the largest obstacles Morgan and her team had to overcome was the insurance companies. “These insurance companies own or have contracts with their own specialty pharmacies, so you’re locked out of the network. I think accreditation is one of the first steps you have to take to get past that.” Acquiring the proper licensing and accreditation ensures Alps is a credible location that providers and insurance companies will choose for their patients. “Case in point,” she explains, “I was calling to get a prior authorization on a local, smaller insurance company, and they said, ‘You know what? It’s not working out with the big pharmacy we’re using. Can we send all our specialty patients to you?’” Accreditation keeps Morgan and her specialty team accountable with their processes and knowledge, which keeps them credible, and it’s one of the sources of the specialty pharmacy’s success.
“Organization is key,” she says. “Some people do it just by Excel sheets and paper files, but I knew I needed to stay really organized. I’m high-technology, anyways, so PioneerRx was excellent in its capabilities with allowing me to use the note features, patient category features, and item category features.” Morgan’s self-professed Type A personality has helped her set clear, organized systems in place. A large whiteboard stationed behind her lists each day of the week and the specific duties she and her staff members must complete each day. As for staffing, Morgan created and filled niche positions as she saw fit. In the beginning, she pulled one of Alps’ top technicians for an hour each day to conduct patient care calls, but as the number of specialty patients escalated from five to two hundred, she was permanently moved to the specialty pharmacy and given the title of “patient care coordinator.” When she began asking for advice from other pharmacists, some recommended designating the task of contacting local prescribers to one person. In turn, Alps Pharmacy created the title of “Director of Sales and Marketing” and filled the position with a salesperson. “We knew that in order to have a specialty pharmacy, we needed to get in front of the doctor, so that’s where the sales and marketing came in,” Morgan explains. Some specialty pharmacies, like Alps Specialty Pharmacy, find it worthwhile to invest in niche positions like these to create a more productive, streamlined workflow.
Although specialty pharmacy is projected to rise in popularity, Morgan says that, because each pharmacy is unique, specialty isn’t ideal for every pharmacy. However, it is worthwhile to research and investigate. Listen to your patients, and look for disease states like hepatitis C that could be the foundation of a potential specialty pharmacy. Put yourself in front of physicians and insurance companies who could benefit from a community pharmacist’s services. Find and connect with pharmacists like Morgan who built their own specialty pharmacies and see what wisdom they have to offer from their experiences. One conversation could be the game-changer that becomes your pharmacy’s “greatness.”