According to the National Center for Biotechnology Information (NCBI), “Over the last 30 years, specialty pharmacy has grown from a notion to a cottage industry to being on the cusp of becoming a major force in healthcare delivery.”
Specialty pharmacy services typically manage the delivery of and support for medication and medical products that are expensive, require special handling or management, and present reimbursement challenges. Specialty medications include oral medicines, infusion therapies, and biologic products for serious conditions.
The American Pharmacist’s Association says, “Specialty pharmacy focuses on high cost, high touch medication therapy for patients with complex disease states. Medications in specialty pharmacy range from oral to cutting edge injectable and biologic products. The disease states treated range from cancer, multiple sclerosis, and rheumatoid arthritis to rare genetic conditions.”
Specialty medications can present significant challenges to patients that specialty pharmacies are there to address. Two key considerations are cost and access. The cost of specialty medications often surprise and intimidate patients, and it is important to be able to help patients access the medications and use them in order for their treatment to be successful.
Coverage criteria for specialty products can be much more complex than with traditional medications, and paying out of pocket for therapy may not be an option except for the very wealthy. Specialty pharmacies have experienced staff ready to help patients navigate their insurer’s benefit coverage, and reassure patients that they will be able to afford treatment.
High Touch Service
Specialty pharmacies offer high-touch services not commonly associated with pharmacies. Pharmacists are specialty-trained and function as part of a patient’s collaborative care team. Many patients report enhanced satisfaction due to fewer complications in drug treatment; improved laboratory communication; medication monitoring; reductions in unnecessary medications; and shorter hospital stays resulting in lower treatment costs.
Specialty pharmacy services include patient training, obtaining prior authorizations, and assisting with medication benefit investigation and resolution to ensure that patients have access to the treatments they need. Full-service specialty pharmacies typically offer a dedicated patient contact who has the ability to handle both clinical and nonclinical conversations and is able to provide patient support around the clock. Specialty pharmacy staff often service a crucial part of a patient’s support team as they often are the first place a patient visits after a difficult diagnosis.
As the model of collaborative healthcare expands and grows, every person who participates in patient care will have a distinct role to play, tied directly to patient outcomes. Specialty pharmacies are increasingly bearing the charge of dispensing, distribution reimbursement, case management, and other services that serve a patient’s specific disease needs.
An aging population and the race to find therapies for chronic conditions are likely to result in a steady rise in the development and use of specialty medications. Specialty pharmacies play an important role in monitoring and documenting patients’ progress as they undergo specialized treatment regimens. While the specialty pharmacy does not take the place of the primary caregiver; it is a valuable and complementary service that can only improve patient outcomes.