Specialty Pharmacy in Retail: A Face-to-Face Patient Experience

Community-based specialty pharmacies are poised to set the trend for delivery of specialty drugs because of their emphasis on the personal care and patient management that help ensure positive outcomes.

While brand name products are declining in market share and the generic market is holding steady, another part of the pharmaceutical industry is rapidly rising and presenting new growth opportunities for pharmacy in the community setting. This is specialty products.

Specialty medications are used to treat complex and chronic conditions such as cancer, multiple sclerosis, and rheumatoid arthritis (RA). These drugs are typically high-priced—the average is $3000 per month. They also require significant coordination of care and typically have relatively complex data requirements involving the manufacturer. For example, hemophilia treatment can cost the patient and the health plan more than $500,000 per year in drug costs alone.

This segment of the industry continues to grow at a double-digit rate. For example, it is forecast that Humira, which is used to treat both RA and psoriatic arthritis, will be in the number 1 drug in the world by 2018. It is expected to have sales of better than $18 billion per year.

More companies are developing specialty drugs. According to a 2013 report of the Pharmaceutical Research and Manufacturers of America, 907 biologics were under development. Among these were 338 cancer therapies and 71 drugs for autoimmune disorders. And IMS Health indicates that specialty pharmacy is taking up a growing portion of new drug development. Of the 39 new drugs approved by the FDA last year, 30 were specialty drugs.

Community Pharmacy Managing Disease

Community pharmacy has enjoyed great success in the marketplace and much praise from the health care community. The pharmacies in this setting have led the industry in maintaining a high level of patient compliance by counseling their patients to assist them in managing their particular disease(s).

Community-based specialty pharmacies are poised to represent a trend in the delivery of these products. These pharmacies consistently add significant value to the specialist and the patient by concentrating on the holistic delivery of both the product and the supportive care products. For example, the pharmacist is in a great position to coordinate the use of the oral chemotherapeutic agent and the products used to combat the typical side effects seen with these agents in cancer patients, such as nausea and neutropenia. Oncology is a complex disease state that requires this type of holistic approach to therapy to have an effective response to the drug regimen.

The most significant difference between community-based specialty pharmacy and the central fill specialty pharmacy has been the community pharmacy’s ability to provide expert and focused therapy management and related services in a face-to-face manner. Patient management has been a true value for specialty pharmacy. The fact that the community pharmacy can provide these services at a face-to-face level is coupled with the close relationship these pharmacies typically develop with the oncology practices in their respective areas.

Reimbursement is key to any pharmacy dispensing products costing an average of $3000 per month or more. The benefits the pharmacy can provide to the payer include the tracking of compliance and persistence and the ability to monitor price trends in these expensive disease states. Community pharmacy can take advantage of this trend by offering competitive services on products billed through the pharmacy billing systems.

The success of the specialty pharmacy model in controlling the cost and utilization of these products is what led the managed care industry to make expanded use of this model. The result is that this access provides an increasing opportunity for community pharmacy to participate in specialty pharmacy services and distribution for the oncology patient.

Community pharmacy needs to establish its value and niche in oncology practice to contract with plan sponsors and manufacturers to be included as a specialty pharmacy provider. Community pharmacy has long proved its value in the management of the HIV patient through face-to-face interaction and a close relationship with the provider. This model can be used to develop the same value proposition for the oncology patient as more products come to market in the oral space and the disease continues to be treated as a chronic condition.

Creating a Successful Specialty Practice

To successfully create a specialty pharmacy practice, community specialty pharmacies will need to develop much closer associations with manufacturers of specialty products. These relationships will lead to better access and fee-for-service opportunities with the manufacturer. These services include but are not limited to:

• Reimbursement support
• Therapy management
• Patient counseling
• 24/7 clinical support
• Patient registration
• Clinical tracking
• Reporting

The community pharmacy can share the benefit of its experience with the targeted patient population and can also help the manufacturer with prelaunch planning and ongoing decision-making. The ability to provide real-time, baseline data about the patient population, use of current therapies, and information on prescribers could offer keen insight that may not otherwise be available in a timely fashion.

Also, by having access to the patient’s entire drug history, the community pharmacy may provide the manufacturer partner with utilization and outcomes data to help trend the progress and issues of present and future medications. The ability to capture and share these data presents a unique opportunity for community pharmacy.

Another key advantage for community pharmacy is to be able to address issues for patients with multiple conditions, since patients treated with specialty products generally have multiple disease conditions. A disease management approach that addresses all the needs of a given patient would both enhance care and provide very effective management services for both the manufacturer and the plan sponsor. Here are some scenarios where this strategy would work:

• A combination of community pharmacy dispensing and central distribution of pharmacy order fulfillment for specialty medications within targeted disease states
• Clinical programs that will positively impact appropriateness and utilization and ensure proper compliance with and persistency to prescribed therapies
• Disease management programs
• Reimbursement support transparent to the community operation
• Ability to accept assignment of benefits for physicians and the payer
• Benefit design and formulary consulting
• Ability to provide immediate drug access to the patient

Commitment to infrastructure, development of managed care organization relationships, and development of relationships with the manufacturer, as well as relationships with hub services offered by the manufacturers, will ensure a place in specialty therapy management for the community pharmacy. SPT

About the Author

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