Blog

As healthcare providers, we know firsthand how critical it is to manage complex treatments for patients with chronic or rare conditions. Whether it’s ensuring timely access to life-saving medications, coordinating prior authorizations, or managing side effects, specialty pharmacy services often require resources that stretch even the most capable teams.

For many clinics, hospitals, and private practices, juggling these responsibilities while maintaining a high level of patient care can feel overwhelming. Outsourcing specialty pharmacy services has become a game-changer in this space—not just for reducing administrative burdens but also for improving the quality of care delivered to patients.

Key Takeaways

1. Patient-Centered Focus: Outsourcing allows healthcare teams to focus more on direct patient care by alleviating administrative tasks related to specialty medications.
2. Access to Expertise: Partnering with a specialized pharmacy provider brings access to professionals who understand the intricacies of specialty medications, including distribution, adherence programs, and insurance challenges.
3. Enhanced Efficiency: Streamlined processes like prior authorizations, appeals, and refill management free up your staff’s time and reduce delays in treatment.
4. Improved Outcomes: With better medication access, adherence monitoring, and comprehensive support, patients experience improved outcomes and satisfaction.

Specialty Pharmacy and Complex Treatments: The Bigger Picture

When patients face complex medical conditions like cancer, autoimmune diseases, or genetic disorders, their treatment often involves specialty medications. These are high-cost, high-touch therapies requiring meticulous handling, administration, and monitoring.

Here’s where the challenges arise for healthcare providers:

• Prior Authorization Requirements: Specialty drugs often come with layers of red tape from insurance companies. Securing prior authorization alone can take hours of back-and-forth with payers.
• Patient Education Needs: These medications may have specific storage, administration, and side effect management protocols that patients and caregivers need to fully understand.
• Time-Intensive Coordination: Managing these prescriptions involves collaboration between healthcare providers, pharmacies, and payers—a process that’s both time-consuming and prone to bottlenecks.

Outsourcing specialty pharmacy services addresses these pain points while offering much-needed relief to healthcare teams.

Step-by-Step Benefits of Outsourcing Specialty Pharmacy Services

Let’s break down exactly how outsourcing works and why it’s a worthwhile consideration for your practice.

1. Streamlining Prior Authorization

One of the most time-consuming parts of prescribing specialty medications is prior authorization. Outsourcing providers have dedicated teams trained in navigating insurance policies and payer-specific requirements.

• What They Do: These teams handle everything from initial submission to follow-ups, ensuring faster approvals.
• The Impact on Your Practice: Your administrative staff spends less time on paperwork and more time supporting clinical operations.

For example, a rheumatology clinic prescribing biologics for rheumatoid arthritis outsourced their prior authorization process. Within months, approval times dropped by 30%, allowing patients to start treatment sooner.

2. Managing Specialty Drug Distribution

Specialty pharmacies are equipped to handle the storage and distribution requirements for these medications, which are often temperature-sensitive or require special handling.

• What They Do: Coordinate deliveries to ensure medications arrive safely, on time, and in the right condition.
• The Impact on Your Patients: Patients avoid gaps in their treatment regimen, which can be critical for conditions like multiple sclerosis or oncology.

3. Patient Support Programs

Patients on specialty medications often require robust support systems to adhere to their treatment plans. Outsourced services include education, adherence tracking, and financial assistance coordination.

• What They Do: Provide one-on-one counseling, reminders for refills, and resources to help patients understand their medication.
• The Impact on Your Patients: Improved adherence leads to better outcomes and fewer complications.

Consider a gastroenterology practice that partnered with an outsourced provider for patients on biologics for Crohn’s disease. With adherence tracking in place, hospitalization rates among patients decreased by 20% in a year.

4. Appeals and Denials Management

Unfortunately, insurance denials are common with specialty medications. Outsourcing providers handle these challenges with specialized teams who understand payer protocols and appeals processes.

• What They Do: Review denial reasons, gather necessary documentation, and resubmit appeals.
• The Impact on Your Practice: Faster resolutions mean fewer disruptions to patient care and less frustration for your team.

5. Data and Reporting

Many outsourced specialty pharmacy services include robust reporting features to help practices track patient outcomes, adherence rates, and cost savings.

• What They Do: Provide detailed insights into your specialty medication program.
• The Impact on Your Practice: Data-driven decisions can lead to improved processes and better patient care.

ICD and CPT Codes for Specialty Pharmacy Services

While coding varies based on specific services, here are common codes relevant to specialty pharmacy:

ICD-10 Codes for Common Conditions Treated with Specialty Medications

• C34.90 – Malignant neoplasm of unspecified part of bronchus or lung
• K50.90 – Crohn’s disease, unspecified, without complications
• M05.79 – Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement

CPT Codes for Specialty Pharmacy-Related Services

• 99605 – Medication therapy management services, initial 15 minutes
• 99606 – Follow-up medication therapy management services, 15 minutes
• 99091 – Collection and interpretation of physiologic data digitally stored

These codes can help ensure proper reimbursement for specialty pharmacy-related care.

What Did We Learn?

Outsourcing specialty pharmacy services is more than a convenience—it’s a strategic way to enhance care for patients with complex medical needs. By offloading administrative burdens, improving medication access, and offering comprehensive patient support, outsourcing allows healthcare providers to focus on what matters most: delivering exceptional care.

If your practice struggles with the demands of specialty medications, consider how outsourcing could transform your approach. It’s not just about improving efficiency; it’s about giving your patients the best possible chance at better outcomes.

FAQs

How does outsourcing specialty pharmacy services benefit smaller practices?

Smaller practices often lack the dedicated resources to manage the complex needs of specialty medications. Outsourcing provides access to expertise and services that level the playing field, allowing smaller clinics to deliver the same high-quality care as larger institutions.

Are there risks involved in outsourcing specialty pharmacy services?

The main concern is finding the right partner. Choosing a reputable provider with a proven track record ensures your patients receive the support they need without compromising your practice’s values.

How can I evaluate whether outsourcing is right for my practice?

Start by assessing the administrative time and costs currently devoted to managing specialty medications. If these tasks strain your staff or delay care for patients, outsourcing may be the solution.

Disclaimer

The information in our posts is meant to inform and educate both healthcare providers and readers seeking a better understanding of the prior authorization process. However, it is not a substitute for professional advice. Insurance requirements, policies, and approval processes can vary widely and change over time. For accurate guidance, healthcare providers should consult directly with insurers or use professional resources, while patients should reach out to their insurance providers or healthcare professionals for advice specific to their situation.

This content does not establish any patient-caregiver or client-service relationship. Staffingly, Inc. assumes no liability for actions taken based on information provided in these posts.

For tailored support and professional services,

please contact Staffingly, Inc. at (800) 489-5877

Email : support@staffingly.com