Appreciating the Patient Journey in Specialty Pharmacy

I remember it like it was yesterday. It was my final year of pharmacy school and the light was at the end of the tunnel. Graduation was inching closer with each passing day, which meant more and more of my classmates were getting jobs.

We were all so eager to get into the real world and begin to apply the clinical knowledge we all work so hard to obtain. With the exception of some classmates opting to do a residency, retail pharmacy and hospital jobs were the most prominent among the classmates. I graduated purposefully, knowing I wanted to find the next big thing in pharmacy.

During that final year of pharmacy school, I was fortunate enough to gain the experience of working in a specialty pharmacy, as well as an infusion pharmacy. Seeing how tightly managed care was for the patients of these respective patients helped me realize this is the field I needed to be in.

The talk of specialty pharmacy was in the air. It seemed like everywhere I went and everything I heard or read was of someone talking about how specialty was set to be the next evolution of pharmacy. Most would argue this has now become a revolution rather than just an evolution.

A case in favor of specialty can be made easily. It was and still is predicted that by the year 2020, 50% of drug spend will be due to specialty medications. In my 5 years of specialty pharmacy and managed care experience, I can assure you we are already at this marker.

Although manufacturers have found creative ways to make their specialty medications available to patients for a $0 or near-$0 copay, they are doing this at the client’s (often the payer) expense. Some payers are already trending far ahead of the curve with a specialty drug mix being the main driver of their drug spend. It’s not uncommon to see clients already approaching the 60% mark, meaning 60% of their total prescription drug spend is related to the cost they incur from their members using specialty medications.

But perhaps we need to stop and focus back in on what matters the most: the patient.

What are Specialty Medications?

Specialty medications are designed to treat complex and potentially life-threatening conditions. These therapies often require much more care-management than what he have seen with traditional dispensing.

Examples of these conditions are cancer, hemophilia, pulmonary fibrosis, etc. These therapies include oral, injection (subcutaneous or intramuscularly), intravenous infusion, intrauterine, etc.

More drug manufacturers seem to be moving to a high-touch care model. In this model, they are requiring specialty pharmacies to provide patients with an even more attentive, patient-centric approach.

The Patient Journey

The patient journey is the most critical component for all key stakeholders to understand. This is the lifeblood of what separates a good specialty pharmacy from a great one. With hundreds of specialty pharmacies all competing to win over patients, it will be the specialty pharmacies that are able to offer the most seamless, patient-focused services that ultimately prevail.

The patient journey starts with the first visit to the physician for an unexplained complication. The patient is there in hopes that the complications they are experiencing are nothing more than just a nuisance. At the end of the appointment, the physician has referred the patient to a specialist because the complication is a little more serious than originally anticipated.

At this point, the patient is likely full of anxiety. They just left their physician’s office for the first time carrying a feeling of uncertainty. A week later, they are sitting in the specialist’s office and they get the dreaded news that they have been diagnosed with a disease that will require ongoing therapy for the remainder of their life.

The patient is now on an emotional rollercoaster filled with doubt and anxiety. They are nervous for their future and have no idea what to expect from their new specialty pharmacy, which is completely different than the retail store they always walked into for their medication and talk with the pharmacy staff in person; however, this has now changed.

They will likely have to proceed with obtaining their new specialty prescription filled through a mail order specialty pharmacy where they will have no physical encounter with any representative along their journey. Finally, after several days or even a week, the patient gets their new medication and is hesitant about how to appropriately take it.

Phew, that’s exhausting.

I think that’s an important thought to keep in mind as specialty pharmacy continues to evolve. Specialty pharmacies need to continually perfect their craft in creating the best patient experience possible. Additionally, whether a patient service representative, a pharmacy technician, a nurse, doctor, or a pharmacist, we all need to remember that the patient we are helping is someone’s mother, father, sister, brother, etc. Treat them how you would want to be treated during your own patient journey.

About the Author

Mark Thomas earned his Doctor of Pharmacy degree from Lake Erie College of Osteopathic Medicine (LECOM) and is currently enrolled in the Master 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. Mark spent the past 4 years as a clinical pharmacist in a specialty pharmacy working on high profile initiatives to expand his organization’s national footprint, as well as directly coordinating with patients, prescribers and other healthcare providers to educate and promote the utilization and uptick of generic specialty medication. In his current role as a clinical advisor in the managed care setting, he works directly with clients to help manage and develop strategies that promote optimal health outcomes in the most cost-effective manner.