A recently announced partnership between the Yale-New Haven Health System and Excelera, a national specialty pharmacy network, aims to provide YNHHS pharmacy staff with the tools to more safely treat patients with complex care needs — including the prescription of hard-to-find drugs — in a local setting.
Excelera, which made the announcement Oct. 12, is a national network that now consists of local specialty pharmacies owned by 12 health systems and academic medical centers throughout the U.S. According to Excelera President and CEO Jim Fox, the network provides its members with a national platform for the collaborative development of best practices for patient care, as well as the industry clout necessary to secure access to limited-distribution drugs, which drug companies distribute only to a small number of pharmacies or wholesalers largely because they are expensive and demand for them is low.
“Right now we have access to many specialty medications, but probably very few what we call limited-distribution drugs … Because of the prestigious nature of some of the people within Excelera, that allows us to get more focus and attention,” said Lorraine Lee, YNHHS executive director of pharmacy services. “That means our patients will be able to come to our local pharmacies here, within the Yale-New Haven Health System, and fill their medications kind of close to home, so to speak, as opposed to having to go to some other pharmacy that could literally be in another state.”
According to Fox, the dialogue that led to YNHHS’ entrance into the Excelera system started last spring when YNHHS representatives approached Excelera about joining the network. YNHHS began to roll out its internal specialty pharmacy about six months ago, according to Kerin Adelson MED ‘00, chief quality officer and deputy chief medical officer of the Smilow Cancer Hospital.
Though the number of YNHHS patients who require limited-distribution drugs is quite small relative to the system’s population, Lee said the figure is higher than those of non-academic health systems because YNHHS treats more patients who require tertiary care — consultative care that normally comes on referral from another medical professional and requires more advanced treatments. Additionally, Lee said, limited-distribution prescriptions are often more complicated and carry more risk than non-specialty drugs. Because of this, patients normally require more education from health professionals in how to administer limited-distribution drugs, Adelson said. When local education is unavailable, patients run the risk of misusing the drug with potentially serious side effects. This was the case within YNHHS before it established its specialty pharmacy.
“We had patients that had continued taking the drug after we believed it had been stopped, because these specialty pharmacies kept sending refills,” said Adelson, who oversees the administration of many complex treatment plans in her role at the Smilow Cancer Hospital. “We had patients who didn’t understand how they should take their drug — so, for example, if you’re supposed to take a drug for two weeks on, followed by one week off, they might take it continuously and then have higher levels of toxicity — because we really didn’t have a way to monitor it [locally].”
Lee and Adelson cited the elimination of some of this risk as a major advantage of both YNHHS’ creation of a specialty pharmacy, which jump-started the improvement process, and its entrance into the Excelera system, which they said will continue it.
The Excelera partnership will do this by providing YNHHS with access to a wider range of drugs, as well the expertise of health professionals within other Excelera systems who are dealing with the same challenges YNHHS professionals are.
That, Fox said, is exactly Excelera’s goal.
“It’s really what makes [Excelera’s member networks] great, is [that] they’re committed to patient care, and they’re committed to working with a network on a national level to really make it the premier network from a patient care and specialty pharmacy management point of view,” he said.
YNHHS is the largest healthcare system in Connecticut and includes three hospitals, several specialty networks and a nonprofit medical foundation.