The Value of Specialty Pharmacy as a Career Path

Internships can play a huge role in your future career plans. I remember I had the opportunity of joining one of the hospitals in the United Arab Emirates. As a pharmacy intern, I was checking in with patients to meet their needs.

During this time, I was approached by a patient in his mid 70s who was asking for his specialty medication refill. I tried to look up his medical record to check whether his medications were due for refill.

After the patient had waited for 30 minutes in line, I had to inform him that he must wait another 48-72 hours to obtain a prior authorization (PA) from the insurance company to approve his specialty medication, and only then could we dispense it to him.

The patient was disappointed, he said that he is already in pain and has to take his medication today. I could not handle seeing the patient in distress and really wanted to assist him by expediting the PA process, so he can take his medicine on time. I went back and forth with the insurance specialists, who told me there was nothing we can do and that the patient will have to wait.

At that point, it did not make sense to me that patients who have highly complex diseases wait in the same line as patients who have a cough/cold, acne or with a simple medical condition. It also frustrated me that no one proactively called the patient to remind him that he has a refill for his specialty medication.

This incident was my first encounter with specialty medications. I did not realize there were pharmacies who fully specialize and focus on patients with complex and rare diseases. The patient-centered specialty pharmacy model is intended to provide patients with complex diseases with a thorough and organized model of treatment, deliver improved clinical and economic outcomes, and accelerate accessibility to care for patients.

Specialty pharmacies manage the patient’s specialty medications from A to Z. Providing services of managing medication adherence; education on how to use the medication since many specialty drugs are infusion or injectable forms; proper handling and administration of the drug; careful control of drug dosing and adverse effects; 24-hour access to pharmacists; PA and financial assistance; shipping coordination; reaching the patient proactively for prescription refill and renewal; and patient monitoring for safety and efficacy.¹

Specialty pharmacy is currently found in the United States and in Canada, but nowhere else in the world, yet. I intentionally say “yet” because I am an optimist who hopes to expand specialty pharmacy beyond North America in the near future.

Specialty pharmacy is one of the fastest growing industries in the United States. To serve this blooming industry, National Association of Specialty Pharmacy was founded in 2012. Specialty drugs were expected to account for 50% of US drug spending in year 2020.² Dr. Scott Knoer, former chief pharmacy officer at Cleveland Clinic Ohio and current CEO of the American Pharmacist Association, believes it is a worthwhile business and advises other health systems to get into the specialty pharmacy business.

Reasons to invest in a specialty pharmacy include better patient and provider experience, improved patient health outcomes, enhanced continuum of care, improved supply chain efficiency, and capture incremental revenue and margin. In one of the conferences held by Cleveland Clinic, UAE, Knoer mentions “specialty pharmacy is the new disruption.”

I wanted to be part of this disruption and believe patients with highly complex diseases deserve the attention that they need and us, as pharmacists, are capable of providing it to them. We have capabilities beyond just dispensing and counseling and can add value and optimize health outcomes.

Reflection is Key

Looking back, I cannot imagine that it only took one patient interaction to lead me nicely to where I am today. Reflecting on my internship experience is a key factor for learning about specialty pharmacy. I continued to do my research on this topic and decided I wanted to specialize in this field.

However, I knew if I wanted to enter this arena, I first need to gain practical/academic knowledge to get the needed expertise to implement specialty pharmacy in our region. My reflection process was best led by my two mentors after I finished my internship. My mentors encouraged me to pursue a master’s degree in Pharmacy Business Administration with a focus track in specialty pharmacy at the University of Pittsburgh.

I cannot recommend enough the importance of having a mentor. Their guidance and advice helped me to take on education/career opportunities that otherwise I would not have. I had no clarity in my career path but having visionary leaders as mentors pushed me to find that missing vision and reach my goals.

Advice for Pharmacy Interns and Freshers

If you are a current pharmacy intern or a fresh pharmacy graduate, try to take the opportunity in such situations. Apply for internships. Get involved. Try different fields to see what you like and see where you fit in.

You must take hold of what you want your next five years to look like. Communicate with pioneers in the field of pharmacy and network because it could be your chance to get yourself internship/work opportunities. Attend conferences because it will add a different perspective from what you just learned in pharmacy school.

I remember post-graduation, many pharmacy graduates were lost because we had no guidance. One of my previous managers had advised me to experiment as much as I can while I still have the chance. Experimenting could be in hospital pharmacies, retail pharmacies, pharmaceutical companies, pharmaceutical manufacturers, patient access organizations, insurance companies, and many more.

Different experiences in different fields will help you understand your “why” and enable you to be more deeply committed to pursuing your goals. One of the many quotes I like is by Simon Sinek, who said “People don’t buy what you do, they buy why you do it.”

You will have a hard time persuading people to embrace the profession and efforts to enhance patient care without understanding your "why." During this critical period for pharmacy, it is time to use this power to continue driving the profession forward.

Evolving Pharmacist Roles

Pharmacy is a growing and evolving field and over the next 10 years, I believe pharmacy will not look the same as it does today. Pharmacists will have to offer personalized care to their patients, with the advancement in pharmacogenomics, personalized medicine, and 3D printed compounded medication.

In addition to digital therapeutics, electroceuticals and other medical devices will treat common medical conditions. Pharmacists must adapt and find their space before it is filled by others. They must define their roles and enhance their expertise by gaining new skills or knowledge in these areas of growing business potential.

Pharmacists made a great impact in the United States and Canada for the vaccination program and now we see the fruit in the pandemic and with public health issues. Pharmacists need to build on this momentum of patient trust and move into more visible roles for virtual reality, telemedicine, and advanced biotherapeutics.

Vast opportunities are opening every day for pharmacists, especially with the upcoming complex biological products that need a lot of therapeutic drug monitoring and fine adjustment of doses.

About the Author

Zakieh Abuelkhair, RPh, earned her bachelor’s degree of Pharmacy from the University of Sharjah in the UAE and is currently enrolled in the Master of Pharmacy Business Administration (MPBA) 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. In the past 2 years, Zakieh has worked at Novartis Pharmaceuticals as a Disease Education Specialist and completed her 6-month pharmacy internship at Cleveland Clinic Abu Dhabi. Her current role is working as Pharmacy Operations Manager at Al Thiqa Specialty Pharmacy in an effort to transform the practice of Specialty Pharmacy in the Middle East.

References

1. Specialty pharmacy: A unique and growing industry. (2013). Retrieved 21 February 2021, from https://www.pharmacist.com/specialty-pharmacy-unique-and-growing-industry
2. https:// (2016). Retrieved 21 February 2021, from https://naspnet.org/wp-content/uploads/2017/02/NASP-Defintions-final-2.16.pdf
3. Hospitals launch specialty pharmacies to curb drug costs. (2013). Retrieved 21 February 2021, from https://www.modernhealthcare.com/article/20151212/MAGAZINE/312129963/hospitals-launch-specialty-pharmacies-to-curb-drug-costs