Q&A: Perspective from a Specialty Pharmacy Veteran

Walgreens Specialty Pharmacy

Edward Finn, RPh

As a young pharmacy student at theUniversity of Pittsburgh during the mid-1980s, Edward"Ned" Finn, RPh, had not heard of specialty pharmacy. Noone had. Just 10 years later, he had already worked as partof a team to help develop one of the first specialty pharmacyautomated distribution centers in the United States.

Today, Finn serves as vice president of specialty operationsfor Walgreens Specialty Pharmacy (WSP) and isresponsible for operations in Pittsburgh, Pennsylvania,Ann Arbor, Michigan, Livingston, New Jersey, and Portland,Oregon. He has spent nearly his entire career as apharmacist and pharmacy executive in specialty pharmacysince graduating in 1986. His perspective spansspecialty pharmacy's past, present, and future. Beloware his responses to several questions about specialtypharmacy.

Q: How do you define specialty pharmacymedications?

A: Specialty medications may be manufacturedthrough biotech or traditional drug developmentprocesses. In the specialty pharmacy industry, the terms"biotech" and "specialty" are often used interchangeably. Theterm specialty medicationrefers to the categoryas a whole, whereasthe term biotech medicationrefers specificallyto those medicationscreated through geneticmanipulationssuch as recombinantDNA technology. As a result, use of these 2terms varies.

Generally, these medications are expensive, with challengingdosing regimens and high side-effect profiles.These may be infused, injected, inhaled, or taken orally.Most of these drugs are used to treat life-changing diseases.Patients taking these drugs need a team approach tosupport the physical, as well as the financial, psychological,and social impact of the diseases and therapies used totreat these conditions.

Q: How did you begin your career inspecialty pharmacy?

A: I knew I wanted to be a pharmacist before I was inhigh school. The pharmacists who owned the localindependent drugstore were a big part of our community.My plan was to buy my own drugstore and become a keypart of the community, too, and to help people. But, rightabout the time I was graduating, the business of pharmacywas changing, and the pharmacist-owned corner pharmacywas beginning to disappear. I still wanted to workas a retail pharmacist, so that is what I did for the first fewyears of my career.

Q: How did you find your way into what became specialty pharmacy?

A: Actually, what became specialty pharmacy began asa result of transplant operations being performedin Pittsburgh-area hospitals starting in 1988. Patientswere coming from all over the country to have these proceduresdone. When patients went back home, their localpharmacies did not have easy access to the medicationsand had little knowledgeof how to managetransplant therapies.Specialtypharmacy wasborn from this lack ofaccess, along with theexpense of these medications,the challengesthat come from managing their administration, and coordinating the insurancebenefit.

Q: What was it about specialty pharmacy that caught your interest?

A: In 1991, I joined the local Pittsburgh pharmacy thatstarted a specialty pharmacy. It was really interesting.When I started, we were working with antirejectionmedications for transplant patients,and then we began working withHIV medications. Then, we becameone of the first companies to haveaccess to Crixivan, a blockbustermedication that was the first in anew class of cell protease inhibitorsused in the treatment of HIV.In that first year of filling Crixivanprescriptions, the company wentfrom generating revenues of $50million per year to $300 millionper year.

With that kind of growth, I realized that specialtypharmacy represented an incredible opportunity, and Iwas offered the chance to be a part of a team tasked withdeveloping an automated distribution center. I have beenin specialty pharmacy every since.

Q: What do you like about working in specialty pharmacy?

A: What I like best about specialty pharmacy is beingable to help patients who have life-changing diseases,such as oncology patients and people who havemultiple sclerosis, rheumatoid arthritis, hepatitis C, andother chronic illnesses. The specialty medications areexpensive and can be difficult to administer, so there ismuch more of a challenge to the pharmacist to help apatient get the most from the treatment.

A lot of working with specialty pharmacy has to do withwhat we all went into pharmacy for in the first place: tohelp people feel better. Many of these medications have acomplicated regimen—patients have to take these medicationson a specific schedule on specific days, and it isnot always easy to keep track of what to take on which dayof the week. Also, we work with patients who had beenvery self-sufficient before their disease, and now theyreally need our help.

Q: What is the typical "day in the life" of a specialty pharmacist?

A: There really is no typical day for a specialty pharmacist.It is the very nature of specialty pharmacythat there is a lot of variety in a specialty pharmacist'sday. Much of a specialty pharmacist's day is spent on thetelephone. They will spend much of their time counselingpatients regarding their medications. Or, they may bespeaking with physicians regarding their patients and themedications that have been prescribed for them. Theyalso may spend time on the phone with insurance companies,but many of the insurance issues are resolved byother members of the team who are experts in helping tocoordinate patient benefits. And of course, a lot of timeis spent filling and checking orders.

Education is key within a specialty pharmacy, sospecialty pharmacists also may spend part of their dayin a classroom, learning about emerging medicationsand therapies. Additionally, the specialty pharmacistwill spend time at the front of the classroom, workingwith nurses and patient care coordinators to keepthem informed on the latest specialty medications andtherapies.

Q: And what would you say to pharmacy students about the future of specialty pharmacy?

A: First and foremost, I would tell them that theopportunities in specialty pharmacy are incredible,because of the explosive growth the field is experiencing.Ours is a growing part of the practice of medicine, and itwill not be slowing down anytime soon.

There also are tremendous opportunities in the newtechnologies used in specialty pharmacy. Specialty pharmacyis conducted in a very clinical setting, and the newtechnologies we are using are found everywhere—indispensing the medications, in the systems that we use toconduct and coordinate the treatments, and even in thecall centers we use to stay in touch with our patients tomake sure they are realizing the full benefit of the medicationsthey are taking.

But most of all, working in specialty pharmacy providesan absolutely unique opportunity to assist patients whotruly need our help. As a specialty pharmacist, you domuch more than simply dispense medications. You arehelping people who have developed life-changing diseasesto live a better quality of life. That is what makes pharmacya profession and not just a job.