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Specialty pharmacies toe the line between access, cost and outcomes

It seems that not a week goes by without a new specialty drug being launched. In fact, of the 46 novel drugs that the FDA approved in 2017, 18, or nearly 40%, were considered specialty drugs.

Indeed, over the past decade, specialty medicine growth has outstripped that of traditional medicines in the United States. In 2017, domestic specialty share grew to more than 41%, and it is expected to surpass half of the medicine spending in 2022, according to IQVIA data.

While there is no question that these drugs offer patients a chance to lead better and longer lives, make no mistake, they carry astronomical price tags that are often out of the reach of the average consumer. Experts said that it is not unheard of for a specialty drug to cost $500,000 for a year’s treatment, or for combined yearly treatment costs to reach $700,000.

Pharmacy chains that have carved out a niche in specialty pharmacy are under increasing pressure to find innovative ways to manage these costs, while simultaneously being on the front line of providing the clinical expertise and ongoing clinical support, education and commitment to achieving quality of care that these “high-touch” medications require.

One tactic specialty pharmacies are banking on is looking beyond their own capabilities to establish alliances or to make acquisitions to expand access to specialty drugs, many of which manufacturers provide on a limited-distribution basis.

The rationale is that providing access to these drugs and expert clinical support will enable patients to be more compliant with their drug regimens, thereby reducing healthcare expenditures from hospitalizations and emergency room visits that are often tied to poor outcomes. This becomes more important as pharmacy reimbursement is increasingly being tied to quality outcomes.

Walgreens, a longtime player in the specialty pharmacy field, is taking the lead in expanding access to limited-distribution drugs and offering robust services through Orlando, Fla.-based AllianceRx Walgreens Prime. It is a partnership that combined the drug chain’s central specialty pharmacy operations and mail order pharmacy operations with PBM Prime Therapeutics’ central specialty and mail order more than a year ago.

“The trend we’re seeing more of is drugs coming out around specialty. Half of the new drugs being approved are coming out with limited-distribution networks,” said Walgreens senior director of specialty pharmacy operations Chris Creamer. “We have limited-distribution access at our central facilities through Alliance Rx Walgreens Prime and we’ve extended access across 300 community-based specialty pharmacies nationwide that are located on hospital campuses, in clinics, oncology and HIV practices, and freestanding in communities. We work with our manufacturers and physicians to make sure we put the right drug in the right location where there are patients in need of access, and that helps with access to limited distribution.”

In the case of US Bioservices, another longtime player in the specialty pharmacy arena, being acquired by AmerisourceBergen in 2003 enabled the company to continue to expand its specialty services and therapies that it provides to patients, and to engage more directly with pharmaceutical manufacturers.

“US Bioservices participates in many limited-distribution drug networks,” said Joy Gilbert, US Bioservices’ vice president of operations. “Having AmerisourceBergen as our parent company allows us to leverage the power and scale of a company like ABC, but still remain nimble as a specialty pharmacy business.”

Emphasizing that the industry is moving towards personalized medicine, and that many of the new FDA drug approvals are for drugs that are for very small patient populations, Gilbert made it clear that the drug manufacturer bringing that drug to market has several things to consider. “If there are only several hundred patients in the country, how do I make sure the patients get consistent care and the people caring for them have the expertise?” she asked.

Specialty drugs may be intended to treat as few as 500 patients nationwide, so it is reasonable to believe that individual pharmacies will have limited knowledge about that patient or disease state when dealing with a single patient. “If you consolidate those patients into a limited number of providers, they can get deep expertise clinically in those disease states and understand the socioeconomic and psychosocial profile of those patients, so we can provide better care,” Gilbert said.
When Alnylam Pharmaceuticals selected US Bioservices as its pharmacy partner for Onpattro, or patisiran, infusion for the treatment of peripheral nerve disease, providing quality patient care was at the top of Alnylam’s priority list.

“When choosing distribution partners, it’s important they work seamlessly with our patient services team to help facilitate patient access, both by dispensing therapy to be infused in the hospital outpatient, office or infusion setting, and by providing home infusion services for patients, where covered by their insurance,” said Alnylam spokesperson Hayley Sofer. “One of the most compelling reasons we chose to work with US Bioservices is their commitment to staying with the patient during the entire infusion, which is something not every specialty infusion pharmacy partner will commit to doing.”

Helping pharmacies get specialty drugs to patients as quickly as possible is absolutely crucial, but according to ZappRx, the process of filling them can shave off necessary time between the prescription being issued and it being filled.

“Currently, the prescribing and prior authorization of specialty pharmaceuticals are highly manual and time-consuming processes, causing patients to endure critical weeks before they receive their medications,” said ZappRx vice president of solutions Karen Tirozzi. “With ZappRx, providers and specialty pharmacists can improve the overall process of getting medications to severely ill patients, significantly improving the provider, specialty pharmacy and, most importantly, patient experience.”
Armed with the goal of getting patients on therapy in 24 hours, ZappRx digitizes much of the prescription process. Pharmacies benefit from getting legible, complete scripts that improve time-to-fill by mitigating the inefficiencies caused by manual processes, Tirozzi said.

“Because ZappRx is agnostic to specific specialty pharmacies and particular medications, prescribers are adopting our platform as a one-stop-shop for all their prescribing needs, including prescription enrollment, eligibility, prior authorization and patient consent,” she said. “It makes a lot of sense for a specialty pharmacy to want to have access to this market of prescribers, and benefit from the efficiencies that the ZappRx platform offers.”

Managing costs

Diplomat Pharmacy recently made a move to extend its specialty and infusion capabilities to lower costs for payers and patients. At the end of 2017 and into this year, the Flint, Mich.-based company acquired two PBMs — National Pharmaceutical Services and LDI Integrated Pharmacy Services, which company officials said gave it the assets needed to offer claims processing and PBM processing. In April the two came together as one Diplomat brand: CastiaRx.

Pointing out that Diplomat is selling to health plans and other businesses, Diplomat’s executive vice president of sales and payer strategies Robyn Peters said by offering PBM services alongside specialty pharmacy services, it can customize its solutions to payers and employers.

“What we do on the PBM side,
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