Despite high prescription volumes seen in community pharmacy, traditional pharmaceutical growth has flattened considerably in recent years.1 In contrast, the drug trend for specialty continues to rise at a breakneck pace, with an 18% increase seen in the last year.1 With numerous traditional generic products coming to the market and more and more medications falling under the specialty category, it is becoming apparent that the future of pharmacy is specialty pharmacy.2
Getting involved with specialty pharmaceuticals can help community pharmacies continue to thrive; however, challenges may be faced when entering the specialty pharmacy market.
The first challenge is infrastructure. Specialty pharmacies established in today’s market have spent a considerable amount of time and capital investment to build core competencies, which include extensive call centers, robust operational processes, comprehensive pharmacy systems, detailed and tailored clinical protocols to manage patients with chronic disease states, customizable educational programs for myriad stakeholders, and strong pipeline monitoring.
The second and third challenges are part of an overarching specialty pharmacy strategy development, which includes access to both patients and medications. Trends in the marketplace trends indicate that many payors and manufacturers of specialty products are narrowing their pharmacy networks.
Some of the requirements that may lead to pharmacies being carved out of payor networks or limited/exclusive distribution channels are the ability to provide robust compliance and persistency programs, extensive reporting requirements, rigid call center metrics, accreditation credentials for disease and/or therapy management, time to initiation of therapy, prior authorization success rates, and adverse event reporting pathways. As this industry leaps toward outcomes and a service-based patient care model, community pharmacies are uniquely positioned to provide comprehensive care to patients.
One innovative approach to increase specialty pharmaceutical dispensing at the community level involves specialty-at-retail programs. These programs allow community pharmacies to partner with experts in the field to provide the integrated management, guidance, and education required to manage chronic, complex disease states often seen within the specialty pharmacy domain. This partnership provides local pharmacies access to specialty pharmacy staff to help support the services needed to dispense specialty products. Such services may include meeting the challenges of getting the patient’s medication(s) covered by insurance, as well as the clinical assistance needed to keep patients on therapy once initiated. Specialty-at-retail programs can be individually designed to replicate a company’s brand and/or values within a centralized and controlled location.
Increasing patient access to open-distribution specialty pharmaceuticals through the community setting, providing all-inclusive care, and improving specialty support services are only a few benefits of such a program. Patients, manufacturers, and the community pharmacy all gain from these programs (see sidebar below).
Pharmacies involved with a specialty-at-retail program must understand their specialty population and implement services that continue to offer support within the community setting. The primary goal is placing patients’ needs first and providing them with tools that will optimize their experience while on therapy. In this type of partnership, the community pharmacy adjudicates the claim, dispenses the specialty prescription, and most importantly, continues to provide face-to-face pharmacist consultations to patients and/or caregivers. Specialty claims are often rejected by payors or covered with extraordinarily high copays; however, offering specialty pharmacy support on the back end can improve a patient’s medication access and affordability.
Ad-hoc services frequently encompassed within a specialty-at-retail program include prior authorization management, benefits investigation/verification, proactive refill reminders, pharmacist consultations, and educational support. Not all prescriptions when adjudicated within the community setting will present with barriers to access; however, if barriers exist, specialty partners are capable of initiating the prior authorization process shortly after notification. The overhead for specialty medications is significant, and many community pharmacies do not routinely stock specialty products. Proactive refill reminders can assist community pharmacies with identifying the appropriate time to adjudicate, order, and stock the specialty pharmaceuticals for patient pick-up. In addition, proactive refill reminders can minimize medication waste and prevent a lapse in therapy.
Pharmacists employed by the partnering specialty services provider are another resource that adds value to a specialty-at-retail program. These pharmacists have an abundance of specialty pharmacy knowledge and can assist community pharmacists with patient consultations and inquiries. Taking advantage of external educational programs developed by the partnering specialty provider for community pharmacy support personnel should not be overlooked. Often, these educational programs can be tailored to fit the needs of the community pharmacy and highlight much-needed topics like operations, specialty disease states, adverse event mitigation strategies, medication overviews, and injection training.
One key attribute of specialty pharmacies is their ability to provide relevant and timely communications to patients and prescribers. A specialty-at-retail program mimics and adapts this staple process into the community pharmacy setting. When dispensing a specialty product, it is important for all parties to be kept in the loop about a patient’s prescription. As an example, when prior authorization is required, the specialty partner informs the patient and works with the physician’s office and insurance company to complete the requirements for approval, all while offering status updates to the appropriate individuals.
Last, if through benefits investigation a patient’s medication is deemed not covered, specialty partners communicate options to the patient (e.g., patient assistance/manufacturer programs) to prevent patients from reaching a dead end in their therapy.
One of the most powerful assets pertaining to health care is patient engagement. When patients are allowed to make or influence decisions surrounding their health, they become more invested. While some patients do well with passive care, others may find this inconvenient and frustrating. A program designed to allow patients the option to choose the convenient, face-to-face services of their community pharmacy, along with receiving the additional support crucial for successful treatment with specialty medications, has the potential to reposition the traditional community pharmacy as an all-inclusive resource for both patients and prescribers.
Express Scripts. Components of commercial trend, 2012. www.drugtrendreport.com/commercial/total-trend. Accessed August 8, 2013.
Steiber D, Erhardt D. Specialty pharmacy in community pharmacy: the time is now—and how! National Association of Chain Drug Stores. www.nacds.org/pdfs/membership/white_paper_speciality_pharmacy.pdf. Accessed August 8, 2013.