The document summarizes an interview with Colleen Lindholz, President of Kroger Health, and John King, Senior Vice President of Kroger Specialty Pharmacy, about challenges specialty pharmacies face and opportunities for collaboration with payors and ACOs. Lindholz and King note that reimbursement pressures and changing clinical requirements create challenges for specialty pharmacies. However, collaboration between specialty pharmacies, payors, and ACOs on patient management, data sharing, and value-based programs can help control costs and achieve desired health outcomes.

1. “The collaboration between ACOs, payors and specialty pharmacy will be extremely
important to the cost of care. Collaboration with specialty pharmacies on long-term patient
management when specialty drugs are necessary will help achieve the desired outcomes
that most payors/ACOs are looking for in today’s world,” says Colleen Lindholz, President,
Kroger Health.
Kroger Health is a solution provider at the marcus evans ACO & Payer Leadership
Summit 2021.
What are some of the biggest challenges that specialty pharmacies face today,
regarding the payor landscape?
Lindholz: Continued reimbursement pressures to control payer costs - while increasingly
requiring accreditation, clinical programs and reporting to participate in networks - are
adding cost to pharmacy providers. The limited and narrow networks used to control cost
create frustration for members and providers to route prescriptions appropriately, delaying
therapy start, limiting choice, and reducing opportunity for physicians to manage patients
through a few pharmacies vs. many.
Changing clinical requirements and formulary preferences are also challenging when not
consistently applied or communicated to providers, preventing pharmacies from acting
as intermediaries for physicians to submit clinical information for authorization, and/or
changing preferred medications increase turnaround times to get medication to patients,
creating dissatisfaction for patients and providers.
How is specialty pharmacy adapting to new requests for adherence data and patient
monitoring from the payor landscape?
King: Reporting of patient adherence, clinical outcomes, and data monitoring on disease
specific dimensions are new trends that many specialty pharmacies are now being requested
to align with payor organizations. These items pose many challenges that stem from a lack
of standardization in reporting, thus increasing cost. The monitoring of medication for a
specific patient population is one area where specialty pharmacy can help with patient
compliance. Clinicians within a specialty pharmacy can continuously speak with patients to
follow up on adherence and note that detailed information. The data and assessments can
be collected on the clinical outcomes of a specific patient population.
What advice do you have for a payor or ACO to work successfully with a specialty
pharmacy?
Lindholz: Collaborating on value-based programs promoting drug adherence, ensuring
appropriate dosing and utilization management will be extremely important to the cost of
care. Many times, the process of communicating between a specialty pharmacy and a payor/
ACO takes several days to complete because there is not a direct line of communication.
Collaboration with specialty pharmacies on long-term patient management when specialty
drugs are necessary will help achieve the desired outcomes that most payors/ACOs are
looking for in today’s world. This type of partnership could enrich customized clinical
programs with measurable outcomes that leverage health assets to lower cost of care and
shift care to lower cost, safe alternatives.
How Specialty Pharmacies Can Help ACOs and Payors
Achieve their Desired Healthcare Outcome
Collaboration between payors,
specialty pharmacies and
providers will be key to success
INTERVIEW WITH
Colleen Lindholz, President, Kroger Health &
John King, Senior Vice President, Sales & Business
Development, Kroger Specialty Pharmacy

2. What vision of healthcare should ACOs and payors be most concerned with moving into
2021 and beyond?
Lindholz: The healthcare industry continues to evolve rapidly as costs continue to climb.
Generally, we anticipate ongoing scrutiny of drug prices, decreased participation of
manufacturers in 340B programs, price transparency, a decline in the number of pharmacies,
as independents are unable to retain profit to stay afloat. As the economy looks to recover,
we anticipate small businesses and consumers will lack healthcare insurance or carry high
deductible plans, while the payers will continue to look for ways to reduce costs and
mitigate risks, partnering with organizations like Kroger Health that offers more than the
basic fulfillment of a prescription. Collaboration between payors, specialty pharmacies and
providers will be key to success.
Specialty pharmacy has many challenges in approving medications for an aging
population. How can this be handled in a simplified manner?
Lindholz: As payers and ACOs continue to look for ways to increase formulary adherence
and move patients to preferred formularies, partnership with EMRs and companies like
Kroger Health that are rich in both clinical and consumer data, will be essential in directing
providers to preferred treatment protocols, and will accelerate clinical reviews and/or
appropriate medication switches.
King: Additionally, allowing pharmacies to submit prior authorization requests based on the
clinical information received at intake would also reduce time to get the same information
from the physician staff, while also reducing the administrative burden on the providers.
With most patients having the need to be on multiple medications, specialty pharmacies
would benefit by working collectively with payor organizations by sharing information on
a specific patient who might have previously been on a medication. This could expedite the
process to dispense a new medication.
Sarin Kouyoumdjian-Gurunlian
Press Manager, marcus evans, Summits Division
Tel: + 357 22 849 313 | Email: press@marcusevanscy.com
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Kroger Health
Kroger Health, the healthcare division of The Kroger Co., is one of America’s leading retail healthcare organizations, with over 2,200 pharmacies
and 220 clinics in 35 states serving more than 14 million customers. Our team of 22,000 healthcare practitioners - from pharmacists and nurse
practitioners, to dietitians and technicians – are committed to helping people live healthier lives. We believe in practicing at the top of our licenses
and enabling “food as medicine” to help prevent and manage chronic disease. We are dedicated to providing testing and wellness services to help
Americans combat the COVID-19 crisis. www.krogerhealth.com
About the ACO & Payer Leadership Summit 2021
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