Specialty Pharmacy
What is Specialty Pharmacy
- Specialty pharmacies deal with processing prescriptions for complex disease states like Cancer, Hepatitis, HIV, Rheumatoid arthritis, Dermatitis, Psoriasis, Multiple Sclerosis, etc. Managing such patients requires a higher level of clinical knowledge, understanding of these disease states and the medications.
- Specialty drugs: Medications indicated to treat these chronic and life-threatening diseases are called Specialty Drugs because of:
1) Periodic safety monitoring due to severe side effects.
2) Unique dosing regimens of most of these medications- Cycles of treatments, loading doses, titrating schedules, etc.
3) Specific storage requirements- A lot of these Specialty medications are injections that need refrigeration. Specific shipping procedures apply to these medications.
4) Costs- Most of these cost in thousands to tens of thousands for a month’s supply.
5) Drug-condition and drug-drug interactions: Patients need to take certain labs and caution to take other medications to start treatments on these Specialty medications.
- Specialty pharmacies take a holistic approach in patient care by delivering exceptional customer service and care-coordination. Some of the core functions of a Specialty Pharmacy are:
1) Processing prior authorizations of Specialty drugs and accurate billing.
2) Obtaining financial assistance for patients due to the high costs of these medications.
3) Educating and monitoring of side effects, drugs interactions, labs, administration techniques, storage conditions, proper disposal of hazardous drugs and addressing other clinical situations needed for patient care- All of this along with drug usage and disease state counseling is provided in the form of Initial assessment.
4) Monitoring and reinforcing adherence in the form of refill assessments
5) Continuation of care in the form of re-assessments and care plans as needed.
6) The staff operates with well-directed coordination between patients, providers and the payers, with Patient-Care being at the Center.
- These unique pharmacies are different from other “regular” pharmacies only because they are equipped with trained staff, system requirements and additional compliance criteria from URAC.
- Specialty pharmacy is the future and is a multi-billion-dollar market which has just been introduced to patients, providers, and other players in the gigantic health care industry. More and more community pharmacies, health systems and academic systems are opening their own Specialty pharmacies because of its enormous scope in terms of patient care and thus, the revenue. 340B is another huge potential for these institutions to bank huge profits coming out of sales of Specialty drugs.
- Even payers or third parties prefer Outpatient Specialty drugs that can be self-administered by patients at home rather than inpatient administration which is more costly to them. Invention of Specialty drugs have saved overall health care costs.
- Specialty pharmacy is projected to grow to $500 billion by 2020*
- Specialty drugs currently represent just under 2% of the prescriptions, BUT nearly 40% of spending*
- As of 2019, 60 percent of new drugs awaiting FDA approval were specialty drugs, indicating future growth of specialty pharmacy*.
(* Source: Specialty Pharmacies: Industry Trends and Valuation Considerations. (2020, July 02). Retrieved August 12, 2020, from https://healthcareappraisers.com/specialty-pharmacies-industry-trends-and-valuation-considerations/TheAcentrusSolution. (n.d.). Retrieved August 12, 2020, from https://www.acentrusrx.com/solution)
