Formed in 2004, ACS set out to change the landscape of the specialty pharmacy marketplace with one simple goal; to put the “special” back in specialty pharmacy. Due to the rapid consolidation of the industry and the robust pipeline of biotechnology drugs on the horizon, physicians, payors, patients and pharmaceutical manufacturers were seeking an organization that could provide a high level of service, reimbursement expertise, customer satisfaction and clinical knowledge that could manage patients as an extension of the specialty practice or clinic. With many of the specialty drugs in today’s market in limited distribution and creating reimbursement hurdles, the need for a customer centric reimbursement savvy organization has become evident. As physicians, payors and pharmaceutical manufacturers were faced with these challenges, they would seek to partner with an organization that could seamlessly handle its large patient base while providing reimbursement expertise and solutions in order for patients to start therapy as cost effectively and efficiently as possible. ACS would design itself as this organization.
ACS was set up into two separate operations under one roof in order to provide to all parties involved in the specialty pull through process a one stop shop. The first component is the Specialty Pharmacy (SP). This component provides physicians and their staff with assistance on the pull through process in order to provide patients with efficient and cost effective delivery of specialty medications directly to their home while always providing consistent and exceptional customer service. In just four years the SP component at ACS has grown to manage over 12,000 active patients and has compiled a referring physician database of over 4,000 physicians that include loyal prescribers from large institutions such as Dana Farber, MD Anderson and Yale University Medical Center.
The second component, the Pharmaceutical Services Organization (PSO) has been derived from our experience in managing over 12,000 active patient’s lives within our SP component. The programs that are managed by ACS have assisted many of our manufacturer customers by enhancing access to their medications for patients. ACS limits access issues to specialty drugs through such programs as reimbursement hubs, copayment assistance management, free drug programs, free drug conversions and clinical management programs.
Through the operation of our specialty pharmacy we have experienced the access issues that a patient faces firsthand. We consider this to be our most important competitive advantage. It has also allowed us to embrace the philosophy that a patient is an extension of the PSO program and that the program is not a success unless the patient receives their medication in a cost effective and expeditious manner. We thrive to provide this service daily to our patients and manufacturer customers and in order to do so ACS has a process in managing PSO services like none of our competitors.
For instance, while managing a HUB program for a manufacturer customer we have noticed that speed to therapy can be delayed when a referral is triaged to a specialty pharmacy provider. The reasons that this can happen can be caused by prior authorizations, medical appeals and prescription clarifications to name just a few. Essentially what happens is a prescription is triaged quickly from a HUB to a specialty pharmacy but it is incomplete. It is then added onto an overworked insurance specialist’s or pharmacy technician’s work list to complete all of the steps necessary to provide a patient a complete insurance investigation. This is the point of the process when a patient’s prescription experiences the largest delay in obtaining benefits. At ACS, we have identified this issue and in order to improve it, ACS will initiate prior authorizations and follow up with the insurance company until they have been approved. When a prior authorization has been denied then ACS will perform step edit appeals in an effort to overturn an insurance company decision. ACS will also provide prescription clarifications before a referral is triaged. All of these items will provide an improved turnaround time after a referral is triaged as insurance specialists will work through these referrals quicker than others on their work list.
Due to our rapid growth and the expertise possessed by our organization through the management of our numerous PSO services, ACS became a widely marketable organization. On July 15, 2008 ACS was acquired by Omnicare (OCR) a publicly traded company on the NYSE responsible for 2.5% of the national drug spend. Established in 1981, Omnicare is a long-term healthcare provider of pharmacy services integrated into many facets of the healthcare industry. With the numerous organizations under the Omnicare umbrella they work in conjunction with one another to provide a manufacturer with the Omnicare Solutions brand. Omnicare Solutions is an unprecedented package of manufacturer focused product support services. The combined service capabilities available with Omnicare Solutions support the answers to challenges at all stages of the product’s life-cycle, from initial launch and distribution, to on-going patient education, reimbursement and beyond. Omnicare is truly a one-stop shop for pharmaceutical manufacturers and is projected to produce $6.2 billion in revenue in 2009, of which ACS is responsible for $350 million.