What Is a Specialty Pharmacy?

A specialty pharmacy is defined not by the site of care but the model of care and the type of services it provides to patients.

The Academy of Managed Care Pharmacy (AMCP) defines “specialty pharmacy” as follows:

“Specialty pharmacies are distinct from traditional pharmacies in coordinating many aspects of patient care and disease management. They are designed to efficiently deliver medications with special handling, storage, and distribution requirements with standardized processes that permit economies of scale. Specialty pharmacies are also designed to improve clinical and economic outcomes for patients with complex, often chronic and rare conditions, with close contact and management by clinicians. Health care professionals employed by specialty pharmacies provide patient education, help ensure appropriate medication use, promote adherence, and attempt to avoid unnecessary costs. Other support systems coordinate sharing of information among clinicians treating patients and help patients locate resources to provide financial assistance with out-of-pocket expenditures.”

As Adam Fein has noted, AMCP is forced to acknowledge that “specialty pharmacy” reflects a pharmacy’s business decision, rather than a regulatory reality. A pharmacy can designate itself a “specialty pharmacy” if its business focus is self-administered specialty pharmaceuticals covered under a patient’s pharmacy insurance benefit. In addition to basic product dispensing, patients taking specialty medications often require more complex services than those required for a traditional drug.

Although a majority of the specialty drugs that pharmacies dispense to patients are sold via a specialty pharmacy, any licensed pharmacy can dispense a specialty drug as long as the product can be purchased from a manufacturer or through an authorized wholesale distribution channel.

We must note that a specialty pharmacy is defined by the type of services provided and not by the site of care. The majority of specialty pharmacy products today are handled by large central fill operations. This model has evolved over the past decade with prescription benefit managers and other managed care organizations building out specialty pharmacies within their organizations and then funneling the majority of their lives through these organizations. However, several large chains and independent operations have also developed over time. The key parameter in all of these operations is the notion of consistent clinical care of the patient with a complex disease state as well as the ability to capture complex data sets to support both the manufacturer and the managed care entity.

As the specialty boom continues, we expect this market of products will top $200 million in annual sales by 2018. Clearly, this is a large market and other models of specialty pharmacies need to be considered. The independent pharmacy community and the small to mid-sized chain community are developing their own models to care for the specialty patient. I believe there is plenty of room in the market to build out these models. The key, as stated above, is consistent clinical practice, as well as consistent data capture ability. It is incumbent on the decision makers in these spaces to create a focused plan designed to meet the demands of the specialty pharmacy product and patient.

There are several models in development now. Community Specialty Pharmacy Network was created to manage independent community-based pharmacies that have entered the specialty pharmacy space with their data management and consistent clinical care capabilities. Cardinal Health recently introduced an initiative termed the “Specialty Pharmacy Alliance,” which is a support center for pharmacies that have a specialty patient in their practice but have not developed the infrastructure to effectively manage that patient. This back-end support center can handle the prior authorization and reimbursement support previously mentioned.

Finally, many chains have launched specialty initiatives designed to support the patient who enters the pharmacy by utilizing central support mechanisms, either developed internally such as Walgreens has done, or by outsourcing this function to an independent central-fill operation such as Diplomat Specialty Pharmacy located in Flint, Michigan.

In the end, what really matter in specialty pharmacy are the services provided to support patient, provider, payer, and manufacturer. The support must be consistent and the systems utilized sophisticated enough to meet the needs of all the constituents. It is not the site of care that is important, but the consistency and quality of the services provided. SPT

About the Author

Nicodemo “Nick” Calla, RPh, JD, is vice president of industry relations for the Community Specialty Pharmacy Network.