What Is Keeping Retail Pharmacies out of the Specialty Game?

Many factors besides limited distribution are affecting access to specialty medications by retail pharmacies, according to a new industry study from Inmar.

As a result of the boom in generics, retail pharmacies are facing declining revenues all over the country. One strategy many of these pharmacies are using to stave off further losses is to incorporate a specialty pharmacy strategy into their business.

A recent industry report released by Inmar, a provider of technology-driven pharmacy returns management and third-party pharmacy management solutions, describes the trends occurring in the specialty pharmacy market and the challenges retail pharmacies face when attempting to enter the market. The report also outlines how community pharmacies can optimize their specialty pharmacy offerings and leverage their high-touch, community position to incorporate a specialty drug strategy into their business.

The future drug pipeline is filled with a glut of targeted therapies, many of which will require strict monitoring by specialty pharmacies. Payers will require patients to be responsible for a higher cost share of their medications, and will enforce more restrictive utilization techniques to ensure that these drugs are producing successful health outcomes. As Adam J. Fein, PhD, pointed out in a recent Pharmaceutical Executive article, new pharmacy network models from pharmacy benefit managers (PBMs) and payers will be increasingly restrictive as they attempt to cull unnecessary spending on costly pharmaceuticals. Despite the narrowing of these networks, Fein wrote there will be “minimal consumer disruption,” because retail pharmacies are so widespread.

But what if the retail pharmacy cannot get access to certain specialty medications? As the Inmar report points out, historically, retail pharmacies do not manage specialty medications well. This is mostly because of problems with medications that are billed through the medical benefit, as well as reporting issues, both to the manufacturer and the payer. William “Bill” Roth, a consultant with Blue Fin Group, maintains that retail pharmacies often have issues keeping specialty medications on the shelf and are not equipped to deal with the benefit challenges (such as explaining copays and dealing with prior authorizations) that can exist with specialty drug dispensing. Roth estimates that as a result of these inefficiencies in the retail environment, 55% to 63% of prescription volume for specialty drugs gets lost.

If retail pharmacies can address these challenges and close the gaps between patients, manufacturers, and payers, they may be able to incorporate a robust specialty strategy at the community level, note the authors of the Inmar report. According to Inmar, the best way a retailer can enter the specialty game is the following:

• Purchase an existing pharmacy in the specialty arena.
• Build a specialty program.
• Partner with other companies to develop resources to enter the specialty pharmacy arena.
• Outsource the distribution and clinical services for specialty pharmacy and only dispense the specialty drugs.

Many of Inmar’s suggestions are similar to those mentioned by Fein in an article that appeared earlier this year in Pharmaceutical Commerce. Dr. Fein also noted in that editorial that implementation of the appropriate technology infrastructure may be one of the most crucial elements to support a “specialty by retail” approach.

Columnist Jim Maguire echoed this sentiment in a recent Specialty Pharmacy Times article entitled “Adding a Specialty Pharmacy to Your Retail Brand.” “While the business opportunities are numerous for regional chains dispensing specialty medications from a branded SP, the key to success lies within the rollout execution,” Maguire wrote. He asserted that retailers should focus on work flow enrollment, patient care management, product pricing, and inventory management to round out their specialty strategy and prepare their businesses for the specialty boom that is predicted to continue well throughout 2018.