Commentary: Specialty Pharmacy Helps Promote Patient Adherence

Michael A. Nameth, RPh, MBA

Mr. Nameth isexecutive vicepresident ofWalgreensHealth Services.

Patient adherence is a key focusfor specialty pharmacy providers.Physicians prescribe specialtymedicationsto treat complex diseasesthat may present challenges to patients.The best way to make sure that patientsexperience the optimal outcome is tohelp ensure their adherence to the prescribedregimen.

A fundamental element to achievingpatient adherence is for the pharmacy toadminister a complete educational careprogram prior to and during the courseof therapy. Specialty pharmacists and thespecialty pharmacy care team can promotebetter patient adherence becauseof the high-touch/high-tech approach tohelping their patients, families, and caregiversunderstand the often complicatedrealities of a specialty medication treatmentplan.

Both community and specialty pharmacistsface a number of factors thatcan lead to decreased patient adherence,including medication side effects,dosing schedule, and cost. These samefactors are magnified in the case of aspecialty medication regimen, as themedications themselves can be moretoxic, the side effects are often muchmore exaggerated, and the cost of specialtymedications is, on average, 10 to 15times more expensive. Because specialtymedications are typically either injectedor infused, patients must either have self-injectiontraining, or they must schedulethe medication's administration by amedical professional at a care site.

Patient care programs are developedby clinicians and are designed specificallyfor specialty disease states andtheir treatments. Because of their specializedtraining, knowledge, and experience,members of the specialty pharmacycare team are uniquely positionedto offer the high-touch, high-care levelof patient education and added-valueservice to patients and their caregiversthat ultimately will enhance patientadherence and outcomes. Patientswill begin therapy with an educationalfoundation that prepares them and setsexpectations for the treatment.

The team of specialty pharmacists andother specially trained care team membersis in close contact with the patient.This contact allows the patient to feelmore confident in the level of care andattention he or she is receiving and thereforemuch more able to maintain thecourse of treatment prescribed. Not onlydoes this improved adherence benefitthe patient, but also the patient's family,employer, and the employer's insurancecarrier as well. The health care insurerbenefits from a reduction in total medicalcosts for the patient and improvedsatisfaction. The patient's employer gainsfrom increased productivity at work.The patient also should experience animprovement in his or her quality of lifeat home and at work.

This effective, patient-focused team approachto pharmacy offers a number oflessons for the practice of pharmacy aswell. The specialty pharmacist must executemultiple layers of a care plan whendispensing medications while interactingdirectly with the patient to assess efficacyof the therapy and to offer guidance. Thespecialty pharmacy team is dedicated tounderstanding how the patient is doingwith his or her treatment regimen andknowing when and why a patient experiencesan interruption in therapy. Basedon the reason for the missed dose, thespecialty pharmacy care team will followup as appropriate with the patient or thepatient's physician.

The insurance specialists on the careteam understand the insurance requirementsrelated to specialty pharmacy andcan help the patient in obtaining financialassistance if needed. This allowsthe patient to focus on feeling better andprovides the patient or caregiver somerelief relative to the filing of complexinsurance forms.

Specialty pharmacy is the fastest-growingsegment of pharmacy today,representing more than $70 billion insales. Right now, more than 1000 newmedications are in the pipeline, contributingto a significant year-to-yeargrowth trend for the specialty pharmacymarket. During the next 15 to 20 years,this growth will represent close to a halftrillion dollars, or more than 40% of thetotal drug-spend in the United States.

Specialty pharmacy is all about thepatients, their families, and coordinationamong health caregivers. The specialtypharmacy team must work togetherwith a patient-centric focus. The betterpatients understand their medicationsand possible side effects, the better theiradherence. Specialty pharmaceuticalsneed to be part of the solution to assistpatients in realizing the full benefits ofthese revolutionary treatments.