Clearway Health partners with hospitals and health systems to build or strengthen their own specialty pharmacy program, improve access to care and provide personalized support to patients, families, providers and care teams to eliminate barriers and ensure medications are received on time.
Clearway Health emerged as a solution to improve access to care and manage the complex medication needs of patient populations. A group of solution-seekers created a specialty pharmacy program to serve Boston Medical Center and its patients. Now, Clearway Health serves hospitals, health systems and communities of patients they care for - providing a service that's been proven, lived and experience by our team.
We have a core team with knowledge and experience across multiple facets of the specialty pharmacy industry including:
We deploy onsite dedicated staff and leadership to design and lead specialty pharmacy program operations and ensure optimal clinical performance and financial growth. These leaders are pharmacists and pharmacy technicians who are experienced in workflow optimization, while also having direct access to the comprehensive care team for additional support.
Our leaders have established relationships within the industry, allowing for streamlined workflow optimization, drug access and improved pricing.
Specialty pharmaceuticals are high-cost prescription medications used to treat complex, chronic conditions like multiple sclerosis, cystic fibrosis, cancer and inflammatory conditions. These medications typically require special handling, administration and monitoring by a healthcare provider to make sure the medication is working as intended, side effects are tolerated and proper follow-ups are taking place. Because of this complexity, pharmaceutical manufacturers do sometimes limit the number of pharmacies that can procure and dispense certain specialty medications.
It is important to note that specialty medications are very expensive – often $5,000 or more per month – and most health plans that cover specialty drugs have strict requirements that govern when, where and how these medications get covered and at what out-of-pocket cost share by the patient. Because of the high cost, it is uncommon for the manufacturers of specialty pharmaceuticals to offer copay-assistance and other financial solutions.
Although the definition of specialty pharmacy can vary greatly, it remains one of the largest single areas of spend for health systems, and having a tailored specialty pharmacy strategy for a hospital or health system can provide the opportunity to unlock previously untapped revenue, cost savings and clinical program support.
Specialty lite refers to specialty medications with less stringent requirements that are often available at most community pharmacies. These medications are typically used to treat obesity, HIV, migraines, diabetes, high cholesterol, respiratory conditions, cardiovascular disease and neurologic conditions.
The growth of specialty lite medications has great potential to improve medication access, adherence and lower costs. The pharmacy teams at Clearway Health have expertise with specialty lite medications and can advise our clients in this area.
At Clearway Health, we have seen what a powerful asset a specialty pharmacy can be for a hospital or health system. Not only will bringing special pharmacy fulfillment in house greatly improve contribution margin, it provides patients and the community with a vital service.
When a patient is prescribed a specialty medication, the pathway to getting that medication is often marked with many obstacles. Clearway Health’s mission is to help patients navigate this path and ensure that they are getting needed care.
Clearway Health’s specialty pharmacy model works to proactively identify patients, assess barriers that may prevent care and streamline the medication delivery to the patient. In addition, Clearway Health partners with hospitals to create a secure foundation to care for all patients regardless of independent variables such as health plan coverage, ability to pay and access to transportation.
For a hospital or health system, Clearway Health creates growth and opportunity across the organization:
A streamlined prescription process ensures patients receive their medications on time, obtain appropriate education and take their medication as prescribed. A pillar of our clinical strategy is to improve the prior authorization process with health plans. In the first three months of partnership for one Clearway Health client, we improved their prior authorization turnaround time from 42 to 1.5 days.
Specialty pharmacy is a proven strategy to significantly grow hospital revenue, effectively manage costs and responsibly fund patient support programs that are mutually beneficial to all stakeholders. Our clients have realized significant margin increases from year one onward.
Specialty pharmacy accreditations are awarded by organizations like Utilization Review Accreditation Commission (URAC) and Accreditation Commission for Health Care (ACHC).
URAC defines accreditation as “the process of rigorous review that allows healthcare organizations to demonstrate their ability to meet regulatory requirements and national standards established via a URAC stakeholder consensus process and recognized as key benchmarks for measuring the quality of an organization.”
Often requested and even required in payor, manufacturer and pharmacy benefit management contracts, accreditation is a key in operating a specialty pharmacy at a higher level. Not only does the process provide the pharmacy with an opportunity to re-evaluate procedures, it ultimately improves internal communication and patient care. It improves payor access and unlocks medications that are vital to patient therapies.
Clearway Health offers the following accreditation services:
We hire a team of dedicated resources for our clients – who are not shared with other Clearway Health clients. This could include a Site Director, Clinical Pharmacists, Pharmacy Liaisons, Pharmacists, Fulfillment Technicians, Inventory Specialists and other roles depending on the needs of the client.
Clearway Health provides comprehensive training and onboarding materials to streamline the new hire process and create efficiencies in the onboarding process for site dedicated team members.
Clearway Health provides onsite implementation team members expertly trained in establishing specialty pharmacy services within clinics and pharmacies.
Clearway Health works with our client partners to create a strategy that’s the best fit for them – including recommendations on contract pharmacies. Our collaborative goal is to serve as many patients and fill as many prescriptions within a health system’s pharmacy as possible. Usually, this means that we reduce reliance on contract pharmacies and help navigate prescriptions to decrease leakage outside of the system. We work with our clients to help them keep fewer, strategic contract pharmacies in place to fill specialty medications that may otherwise be difficult to access through their own pharmacy due to payor or PBM lockouts.
Our business-aware approach ensures that our clients successfully achieve 340B qualification for prescriptions through a health system-based pharmacy or a closely aligned pharmacy. There are often unexpected fees and required investments that come along with reliance on contract pharmacies. This could include procuring TPA software along with additional staff to track fees and network providers, keep records, maintain HRSA compliance and prepare for audits. An in-house program maximizes 340B access, which allows our clients to control the quality, patient experience and revenue while reinvesting back into their patients and communities.