Reflecting on the History of Specialty Pharmacy

In the blink of an eye, 20 years have come and gone.

I gave a 2-week notice in November 1996, and took a leap of faith to move to specialty pharmacy. The comment was made that I would return to my retail position in a few months, as this specialty pharmacy thing was not going to last, or it was going to be boring.

Those words worried me a bit, but a change of pace and different opportunities were needed to energize my career; bored or not, I was going to stick it out.

My initial love of the profession of pharmacy occurred in retail. I loved the pace, the fact that every day was different, the patients, counseling on how to properly use an inhaler, and helping select an OTC; most of all the relationships with the community that only a retail pharmacist has from working the bench were fulfilling.

What I found in specialty pharmacy was similar: it is fast paced, there is always something new to learn, and specialty did not steal from retail. If anything specialty filled a void in the profession. Specialty took the burden of dealing with challenging reimbursement, inventory restrictions, REMS requirements, and data reporting that were typically difficult to manage in a retail setting.

My first day as a specialty pharmacy associate was spent in an orientation class learning about the culture, mission, and goals of my new company. There were discussions about who uses specialty pharmacy and why, what it is like to manage a pill burden of 15 prescriptions with different dosing regiments to stave off organ rejection, and what it meant to be hiding an HIV diagnosis in order to feel safe doing routine things, such as grocery shopping.

My introduction to specialty pharmacy was more than a checklist, it was an introduction to teams of people working together to make a difference in difficult situations for our patients. Specialty pharmacy is a business with a purpose: to make the complicated world of difficult disease states a bit easier to navigate and manage for physicians and patients.

Early specialty pharmacies began in the 1970s,¹ and were known for preparing and delivering injectable products, serving populations with specific infusion needs like hemophilia, chemotherapy, and nutritional support services. The phase of specialty pharmacy that changed the entire landscape occurred in the 1990s, as drug manufacturers cracked the code on new drug classes, differentiated molecular entities, and unique delivery mechanisms for a wide range of disease states.

Specialty pharmacy invests in associates through education and training on the disease states being served. As new drugs came to market, or new indications were approved, additional education was provided to cover drug interactions, boosting doses, specific loading doses, side effect management support, and other information to support the patients as they began a new regimen.

Specialty pharmacy set the expectation for clinicians to obtain and maintain a level of competency about the diseases and medications used in treatment. In the 1990s, some specialty pharmacies were partnering with outside entities to offer a certificate programs in disease states, such as HIV and in cases of organ transplantation. An educated and experienced specialty pharmacy staff ensures the best outcomes for the patient and providers.

Specialty pharmacy plays a critical role in inventory management. Drug manufacturers may have the ability to produce a limited supply of drugs to assure every patient who begins therapy will be able to have continued access to the drug; however, the number of pharmacies in the distribution network is limited to specialty pharmacies.¹

Limited access can be viewed as minimizing the competition, but the clinical benefits to the patient and accuracy of data collection and analysis is a benefit that counters this argument. A limited network can be beneficial to the manufacturer, the physician, the payer, patient and pharmacy, as every one of these entities must coordinate their efforts to get a patient set up correctly from the start of therapy.

One of the goals of every specialty pharmacy should be to make their interactions with the patient about the medication and delivery process as simple as possible, allowing the patient to focus on other aspects of their therapy and lives.

The high cost of specialty medications, with a low end spend of at least $6,000 per year, and upwards of $500,000 for orphan disease state therapies, is another driver for specialty pharmacy. The specialty pharmacy is expected to monitor dispensing, ensuring proper dosing, minimal waste for a weight-based product, and adherence to the medication through clinical follow-ups and routine interactions to help monitor effectiveness and minimize side effects.

The data collected from these interactions is analyzed and used to show improved quality of life, decreased hospital or emergency room visits. In many cases, the pharmacy benefit spend increases while the medical spend decreases for a payer.

An increase in prescription spend at the specialty pharmacy is more cost effective than a hospitalization with the increased risk of readmissions. That statement seems hard to grasp when the reported annual spend on specialty drugs was reported at $87 billion in 2012, and is estimated by a Pew Report² to hit $400 Billion by 2020.

In my 20 years of experience in specialty pharmacy, I have witnessed the shift from specialty occupying one or two work stations in the corner of the room, to owning the room and expanding their footprint across the health care spectrum.

From the early beginning of specialty pharmacy and well into the future, the opportunities for a pharmacist are dynamic, challenging, and never boring. Specialty pharmacy will continue to evolve to partner with manufacturers, providers, and patients to meet their needs in the changing health care environment.

References

1. Suchanek, D. The Rise and Role of Specialty Pharmacy, Biotechnology Healthcare, October 2005

2. Specialty Drugs and Health Care Costs: A fact sheet from the PEW Charitable Trusts Nov 2015. pewtrusts.org/specialtydrugs

About the Author

Jill Schachte earned her B.S. in Pharmacy from Duquesne University and is currently enrolled in the Masters of Science in Pharmacy Business Administration (MSPBA) program at the University of Pittsburgh, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines. Jill has spent the past 20 years working in specialty pharmacy, starting as a clinical pharmacist with Stadtlanders Pharmacy and working in a variety of a management roles in specialty pharmacy operations for CVS Health. Jill’s current role is on the CVS Specialty Professional Practice team with a focus on accreditation and compliance for all the specialty pharmacy locations within CVS Health.