What Are Specialty Pharmacies and Why is the Market Growing So Fast?June 28, 2016
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Specialty pharmacies were developed to deliver costly, complex drugs that cannot practically be dispensed through a retail channel. These drugs include injectable and infusion drugs as well as oral medications that require special handling. Specialty pharmacy pharmacists are required to assist patients with the administration of their medications and to monitor their condition.
With an aging population and rapid drug development, the specialty pharmaceutical market is growing fast–by some estimates as much as 30 percent per year. It turns out that one reason for the rapid growth is patient satisfaction. They appreciate the personal service. Insurers like it too–the thorough guidance and monitoring makes it more likely that medications will be used correctly and be more effective.
Going Above and Beyond
Specialty pharmacies employ what the American Pharmacists Association (APA) calls a “patient-focused model.” Services they offer go “above and beyond those typically offered at the retail level as part of their standard of care.” These may include the following:
- 24-hour access to pharmacists
- Adherence management
- Benefits investigation
- Communication and follow-up with the physician
- Dispensing of specialty pharmaceuticals and shipping coordination
- Enrollment in patient assistance programs
- Financial assistance
- Patient education and medication adverse effect counseling
- Patient monitoring for safety and efficacy
- Payer and/or manufacturer reporting
- Proactive patient outreach for prescription refills and renewals
- Prior authorization assistance
Satisfaction Drives Loyalty
What’s not to like? According to CVS Health, “patients are more likely to take their specialty medicine as prescribed and also report high satisfaction with the service they receive.”
“We generally find that people have high satisfaction rates with any specialty pharmacy, and a lot of that is because they’re getting very hands-on, personalized care,” Dr. Alan M. Lotvin, an executive vice president at CVS Health, told the New York Times last year.
Caregivers and family members also appreciate the service delivered by specialty pharmacies. Knowing that their patient or loved one is being monitored, has access to assistance at any time, and has someone looking out for them is an enormous comfort.
Guidance Through a Hard Time
Most patients requiring specialty drugs face serious often life threatening conditions. Cancer-fighting infusions are one of the most commonly used specialty medications. The personal attention given by a specialty pharmacist can help alleviate stress and get patients focused on what lies ahead. In many cases, the speciality pharmacist is one of the first persons people see after learning of a difficult diagnosis. They may nod their head as a doctor prescribes something, but they have much more on their minds. The specialty pharmacist guides them through the medication management process.
Navigating the Coverage Maze
Another benefit of specialty pharmacies is that they help patients navigate their insurance company’s benefit system. Most patients don’t understand terms like non-formulary or prior authorization. Coverage criteria for specialty products can be much more complex than the already mystifying requirements for ordinary medications, and paying out of pocket for therapy may not be an option except for the very wealthy. Specialty pharmacies manage things on behalf of patients.
For the majority of specialty medications, the manufacturers are aware of their high cost and provide co-pay assistance cards to eligible patients that can lower the cost of the medication considerably. The specialty pharmacy will be aware of these discounts and will often have the co-pay assistance cards on hand.
Stephen Lasch (PharmD) of the National Center for Biotechnology Information says, “The importance of a [specialty pharmacy’s] role in monitoring and documenting patients’ progress as they undergo specialized treatment regimens cannot be overstated. Their work cannot —and should not — take the place of the primary caregiver; it is a valuable and complementary service that can only improve patient outcomes.”
Patients love specialty pharmacies because they offer what is mostly missing from today’s managed healthcare system. Personal service, 24 hour availability, detailed instruction and coaching, and a holding hand.