Life in a Specialty Pharmacy

The personal story of a specialty pharmacist and the growth of an industry.

Nicholas Karalis, RPh

If you ask the question “What is specialty pharmacy?” you will receive many different responses.

For payers, like the Centers for Medicare & Medicaid Services, the answer may involve cost. For manufacturers, it may involve benefit analysis and reimbursement assistance. But for me, “specialty pharmacy” means patient care.

As a pharmacist and owner of an independent specialty pharmacy, one of the most rewarding aspects of my work is improving our patients’ quality of life. I think all of the stakeholders would agree that “specialty pharmacy” involves a hi-tech, hi-touch approach to effectively manage patients with chronic conditions requiring expensive medications that may need special handling, and also requiring additional patient support to keep patients compliant—and ultimately improve patient outcomes.

Building a practice that goes beyond the traditional count, pour, lick, and stick mentality is a tremendous endeavor. It requires a great deal of infrastructure, knowledge, and capital. The cards are stacked against you with limiteddistribution pharmaceutical agreements, PBM-owned specialty pharmacies limiting patient access, and networks that only have a select few participating specialty pharmacies.

Our practice is built around “improving our patients’ lives.” With this in mind, we leverage our relationships with physicians and health care professionals to offer a viable solution. We work closely with the medical offices that entrust us with these patients who require an array of different services.

Our collaborative staff works vigorously to ensure that every new patient receives their medication, even if we are restricted because of insurance or manufacturer programs in providing the medication from our facility. We continue working with the referral, sending it to the mandated pharmacy and communicating with both the patient and provider.

One of the most valuable and self-rewarding services we offer is injection-training and face-toface counseling for our patients and caregivers. We provide specialty patients, who require assistance, the opportunity to sit down in a private setting and learn about their condition and medication. We partner with local pharmaceutical representatives to provide starter kits and additional valuable information for our patients. We believe that communication is an important component of improving compliance, adherence, and ultimately outcomes, so we have an ongoing interaction with our patients and their physicians. Our specialty pharmacy services are integrated around the patient and their health care provider.

I believe that community specialty pharmacies have a tremendous opportunity to make a difference for patients who require specialty medications. The process is not an easy one administratively, with just about every patient requiring a prior authorization, follow-up, and insurance verification. You need a dedicated staff with an in-depth understanding of the medications and their respective disease states.

Specialty pharmacy is not an avenue for every community pharmacy; however, if you deliver high-quality service, physicians and patients will surely recognize that community specialty pharmacies are the most appropriate choice for their medication needs.

When you think about it, most current providers of specialty medication are using a DVD for patient education, a nonlocal call center operator, and a UPS driver to deliver their services to their patients. Is this really the appropriate scenario for patients who require complicated care to ensure optimal outcomes?

Serving the Community, Growing Niche Services

Nicholas Karalis, RPh, has owned and operated 6 stores in the 20 years since he graduated from the Philadelphia College of Pharmacy and Sciences in Philadelphia, Pennsylvania. In a recent profile in RxNotes, published by Cardinal Health, his specialty pharmacy team at the Elwyn Specialty Care in Glen Mills, Pennsylvania, is pictured alongside “Nick” and his brother Jim, also a pharmacist. Obviously, the endeavor is a team effort. Founded in 2008, this specialty pharmacy and long-term care facility serves more than 5000 patients living in skilled/assisted living, intermediate care facilities, group homes, and prison systems in the community.

Specializing in a wide range of disease states, Elwyn Specialty Care offers specialty pharmacy services in HIV, oncology, hepatitis C, multiple sclerosis, rheumatoid arthritis, Crohn’s disease, psoriasis, and other areas that require special-handling and self-injection medications. The extensive multiple sclerosis program is just one example of how this pharmacy handles patient care from start to finish—helping patients achieve the best results and optimum treatment for their condition. The process starts with reimbursement and prior authorization assistance and goes on to injection training by trained team members, and also includes refill reminders, delivery, and compliance/adherence and data outcome collecting and reporting.

About the Author

Mr. Karalis is a specialty pharmacist and co-owner of Elwyn Specialty Care in Glen Mills, Pennsylvania. As an independent pharmacy owner, he has seen the field of specialty pharmacy evolve. A leading voice in community pharmacy, Karalis is a founding member and board member of the Community Specialty Pharmacy Network (CSPN), as well as a board member of the Cardinal Health National Home Health Care Advisory Board. Specialty Pharmacy Times welcomes him as an Editorial Board member with this first issue.