Why Pharma Should Be Paying Attention to Health System Specialty Pharmacy Data: Kanika Chandra, PharmD; Tiffany Phung

At Asembia’s AXS26 Summit, The American Journal of Managed Care^® (AJMC^®) spoke with Tiffany Phung, director of specialty pharmacy, value, trade relations, and market access at University of California Davis Health, and Kanika Chandra, PharmD, director of system-wide specialty pharmacy operations at University of California Office of the President. Together, they discussed how health system specialty pharmacies are redefining their value proposition from securing access to limited distribution drugs and generating real-world evidence to navigating prior authorization and building payer partnerships.

This transcript was lightly edited for clarity.

AJMC: How can pharma and health systems work together for real-world evidence collaborations, and what does a successful data-sharing arrangement look like in practice?

Chandra: There is a lot of opportunity for health systems—and specialty pharmacies within health systems—to partner with pharma for real-world evidence generation. It starts with identifying the clinical or medical question we're trying to answer: are we trying to understand how disease states are managed within health systems? What is the patient journey from diagnosis to treatment? What are the decision-making processes?

Specialty pharmacy comes into play particularly when we're looking at the outpatient journey and how the patient is doing on therapy. There is a lot of valuable insight that health system specialty pharmacies document in our EHRs [electronic health records]: adherence, adverse events, time to start therapy, time to discontinuation. These are real-world data points documented in our EHRs by health system specialty pharmacies. Physician notes, historically, don't document that as well.

Pharma companies pursuing real-world evidence often partner with claims data or registry data, but the data in our EHRs is invaluable because it is closest to the patient journey. That is why it is critical for health systems and pharma companies to partner together; as health systems, we bring a dataset that no other entity can. That is the way forward for making these real-world evidence projects sustainable: pharma and health systems partnering, with a focus specifically on the data that health system specialty pharmacies bring to our EHRs.

AJMC: What safeguards are in place to protect patient privacy and data integrity?

Chandra: Each health system is different, but health systems need to think critically about the security of their data and think about it from the patient's perspective. Real-world evidence projects, if patients understood the importance of them, I think they would support them. If there is a rare disease we don't know much about, and we do real-world evidence generation that reveals whether a drug is effective or what its long-term side effects are, information that was not captured in clinical trials, patients would want to know that. They would want to know their physicians are making decisions based on data from patients actually on these therapies. So the question becomes: how do we advance real-world evidence without putting patient data at risk? We must ensure it is de-identified and thoroughly protected. We have strong data governance teams at health systems that keep these guardrails in place.

At least for our system, when we work on real-world evidence projects, we own the data. We, as a health system, protect and own the data—anything we extract, anything we analyze. We work with pharma as a thought partner to develop these projects: What should we be looking at? What was not answered in the clinical trials that real-world data can address? We partner with them in that capacity, but we do not give them the data. We keep it ourselves.

One additional consideration is that if you are looking at a rare disease with an extremely small patient population, we must be extra cautious, because there is a risk of reidentification. The benefit of very large academic medical centers like ours is that rare disease becomes less rare in our system due to our size. That means larger n values and greater patient data security. That is what we have learned through these real-world evidence projects.

Phung: I would add that the review for the release of this information is not determined by one person. Because we are a public entity, we have data governance that provides that safeguard. We have a compliance team and a legal team. We hold our patients' privacy to the utmost level. There is data governance at every UC [University of California] site and at the Office of the President to provide that guidance and safeguard.

AJMC: What strategies have you found most effective in negotiating or expanding health system specialty pharmacy access to limited-distribution drugs, and where do the biggest friction points still exist?

Phung: Attending conferences like this one, as well as NASP [National Association of Specialty Pharmacy] and COPA [Community Oncology Pharmacy Association]. Yesterday, in fact, we presented on why pharma would want to work with health system specialty pharmacies, showing our capabilities and our value. We also host onsite visits for our pharma partners. There are challenges on both sides, but if we can understand each other's mutual benefits and meet in the middle, that helps. The starting point is always a conversation about what we can do together to improve the lives of the patients we treat and manage.

Chandra: Education has been the most successful aspect of gaining access to ultra-limited or limited distribution drugs. Educating pharma companies on exactly what we do for our patients: how we service them, how we improve the patient experience, how we improve the metrics that matter to pharmaceutical companies making distribution decisions. Things like time to therapy, adherence, adverse event management, the care plans we develop, how we address social determinants of health, how our pharmacists are embedded in clinic and closest to the patient journey, how we provide insight to providers on which drugs in a therapeutic area present the least resistance for patient access, and how integrated we are with the clinics.

These are the things we need to communicate to key decision makers at pharma companies. That means everything. Tiffany mentioned things like engagement, presenting our value, showing how many patients we actually service in a given therapeutic area. Sometimes companies underestimate our size or the number of patients diagnosed with a particular condition in our health system. We consistently see a disparity between what our data shows and whatever sources pharma uses.

Because our pharmacists are embedded in clinic and practicing under collaborative practice agreements—actually prescribing these drugs—they are an integral part of the care team. When we demonstrate that value proposition, pharma recognizes that partnering with us for access is not just a dispensing component. It is the entire management of the patient's clinical journey. That is something you cannot get from other pharmacies.

And the real-world evidence partnership is the natural next step: if we first gain access to a drug and dispense it in our pharmacies, we generate valuable data in our EHR. We can then use that data for a real-world evidence project. Showing that big picture is what pharma is attracted to, and we have seen positive responses when we present that value proposition. Explaining our model and how close we are to our physicians and how we impact the physician's journey in getting patients on therapy has also been very impactful.

AJMC: How is UC Davis leveraging its outcomes data to engage payers more effectively, and how are you seeing that evidence actually move the needle on coverage decisions?

Phung: This is probably the biggest barrier for us. We are not naive to the process. Showing a value proposition is only one layer; there are many more. We are working on a few payer initiatives where value-based care is of utmost importance. The documentation we are currently providing becomes very important in that context, and we can look back historically to obtain what we need. There are operational metrics, and there are data points we can add going forward if we are not already capturing them. We are learning as we go, but we also understand there are many requirements payers have on the pharmacy side, and we are continuing to adapt.

AJMC: How is UC Davis Health working with payers to streamline the prior authorization process for specialty drugs, and are there specific collaborative models you have found promising?

Phung: One area where we have found particular value is working with a subset of payer partners to access formulary data and reports proactively. This allows us to anticipate plan-level formulary changes before they create gaps in patient medication access, and to manage workload more strategically rather than reactively.

Payers that maintain active electronic connections to Real-Time Pharmacy Benefit and electronic prior authorization solutions have been the most constructive partners for us in practice.

AJMC: As these partnerships mature, what does the next frontier look like for health-system specialty pharmacies? Are there collaboration models you see emerging that the field has not yet fully embraced?

Phung: We expect to see technology take on more of the manual authorization burden, with greater transparency for patients and more reliable real-time decision support for clinicians. The opportunity ahead is shifting from reactive problem-solving to genuinely proactive, data-informed care.

We can also expect Health System Specialty Pharmacies [HSSPs] to get more involved in research and real-world evidence projects in the future. Our providers are looking for support in this space, and HSSP pharmacists provide a good mix of clinical knowledge, insight into the outpatient medication journey, and project management to help support our physicians and develop projects to show the value of health system specialty pharmacies. This involves initiatives like patient identification. So, we can expect to see growth in that area amongst HSSPs in the future.