Disease Mangement

Two Companies Combine Specialty Pharmacy and Disease Management

Reprinted from the November 2005 issue of SPECIALTY PHARMACY NEWS, a monthly newsletter designed to help health plans, PBMs, providers and employers manage costs more aggressively and deliver biotechs and injectables more effectively.

As the influence of disease management in specialty pharmacy grows, many companies are either adding a DM component or expanding their existing one. However, two companies have taken a different approach. Axium Healthcare Pharmacy, Inc., a specialty pharmacy provider, and Specialty Disease Management Services, Inc. (SDM), a DM company, reported on Sept. 26 that they have formed a joint venture called Ariston Health Management, LLC, based in Jacksonville, FL.

The companies say that the new firm will offer an integrated health management approach, combining DM and specialty pharmacy. Services will include com-munity-based care by pharmacists and nurses, medication delivery, and education and treatment strategies focused on a patient’s specific therapy. This approach, they say, is designed to increase compliance and maximize outcomes among patients, while helping to better manage costs associated with complicated diseases. The new company will look to not only health plans but also third-party administrators, employers and government providers for business.

Evolution of a Company

Before the formation of Ariston, both Axium and SDM were independently considering ways to expand their offerings.

From SDM’s experience in the DM industry, in which it works with diseases such as HIV/AIDS, asthma, diabetes, congestive heart failure and hypertension, “We noticed that in particular with some diseases, there were some chronic conditions with high-cost pharmacy and a high-touch approach involved,” says CEO Frederic Goldstein, who will also serve as the CEO of Ariston. “Traditionally, there were two approaches to these conditions: a straight disease management approach or a specialty pharmacy approach. We thought that if we wanted to get the most bang for our buck and offer the most efficient service, we needed to integrate the two services.”

Executives at Axium were also considering a different tactic.

“Axium was looking to identify an innovative approach to entering the managed care market,” says Bill Bolgar, Pharm.D., vice president of sales for the company, which provides specialty medications for conditions such as hepatitis C, cancer, rheumatoid arthritis, growth hormone deficiency, HIV/AIDS and multiple sclerosis. Axium’s president, Mark Montgomery, will also serve as president of Ariston. “We were relatively new, and we needed a different story than our larger competitors.”

Each company, though, wanted to retain its original approach rather than completely revamping what it was doing — a way of thinking that led to the current partnership.

Bolgar says that his company was interested in SDM as a partner after it heard through some pharmaceutical manufacturers that SDM “had an innovative approach to disease management. And there were a lot of similarities between our two companies, in terms of size, structure and where we wanted to go.” SDM was also impressed with the comparable philosophies and interests, says Goldstein.

Benefits of Collaborative Approach

The synergistic approach will meld the companies’ attributes into a more intensive, high-touch company, says Goldstein.

Bolgar points to the number of specialty pharmacy DM programs that have a mainly telephonic relationship with patients. He notes that in these situations, “You can’t really validate what’s being reported by patients.…We will corroborate what we’re learning on the phone with the hands-on experience of Specialty Disease Management.”

This hands-on experience will be by SDM’s field-based care managers, which go out into the community to help coordinate care, confirm that a patient’s therapy is appropriate, educate the patient and allow the patient to manage his own care. These managers, Bolgar asserts, will validate the data that Axium already has.

“Ultimately, we will have a great data set to report to our customers,” he says. “We will have both clinical and financial information.”

It is this shared data, he maintains, that will give Ariston a “big advantage over our competitors. We will differentiate ourselves by pulling medical and pharmaceutical data together. We think we have found a way to do this.”

Axium also will be able to assist with formulary development, contends Bolgar.

Judy White, vice president of health services for SDM, says the treatment platform is “nationally recognized, evidence-based guidelines. For example, with the treatment of HIV, we use DHHS [i.e., U.S. Department of Health and Human Services] guidelines.” For cancers, she says, the company draws from a number of sources: the National Comprehensive Cancer Network, American Cancer Society, American College of Surgeons, National Cancer Institute, Centers for Disease Control and American Society of Clinical Oncology.

Goldstein says that treatment checkpoints will ensure that patients are responding to their treatment — and if they aren’t, that treatment then can be modified. “We want to make sure that patients are getting the right therapy and maximum benefits,” he says.

Payers, in turn, “can feel comfortable” that their clients are receiving the most appropriate therapy, he says. “They will have one company to turn to for all of these clients,” says Goldstein, who contends that Ariston will offer “improved clinical outcomes and lower costs.”

While Ariston will initially focus on hepatitis C, HIV/AIDS, schizophrenia and cancer, “over time, I believe we will add additional disease conditions,” says Goldstein. He explains that the pipeline will be one growth factor, as will input from Ariston’s clients.

Asked about bringing additional companies into the arrangement, he says that it has not been looked at “but this has not been ruled out.”

The new company does not have any active customers, but its goal is to “have a customer on board in January,” says Bolgar, who also points out that there are “a couple [potential customers] in the pipeline right now.” He says that the “self-insured market, direct to employers and third-party administrators are where we see our initial targeting.” Bolgar also says that Axium and SDM are scrutinizing their own relationships, particularly with Medicaid programs, and that this may lead to “some demonstration projects” for Ariston.

Each company will continue to function on its own in addition to growing Ariston through a collaborative approach. But the two expect lessons learned through Ariston will translate to their respective companies.

“We see it as an avenue to approaching different customers than specialty pharmacy has traditionally approached, such as employer groups,” says Bolgar of Ariston. “There is an upside as far as a broader customer base.”

Goldstein concurs. “Ariston expands our ability to go in and offer standard disease management on asthma and diabetes and…also provide [companies] with this specialty pharmacy product. It gives us additional programs to go talk to a payer about.”

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