It’s no secret that declining margins, low reimbursement, DIR fees, and the need to fill a higher volume of prescriptions in record time have, combined, become an Achilles’ heel for many pharmacy retailers. Less well-known are the retailers that have carved out a niche in specialty pharmacy and are sprinting forward and experiencing less pain than their retail brethren that have not yet stepped into this rapidly growing and profitable arena.
In fact, over the last 12 months, specialty is growing by 10% on a dollar basis, while traditional products are flat, according to IQVIA vice president of industry relations Doug Long. “Specialty now accounts for 49% of dollar sales,” Long said.
Retailers that delve into specialty have the potential to boost their bottom line, as well as the ability to accentuate their pharmacists’ relationships with patients to improve their health.
Publix’s success in specialty pharmacy also opens a window on the opportunities for retailers to serve patients in their communities.
A Growing Roster
Pharmaceutical companies are instrumental in helping specialty pharmacies be successful. Indeed, new treatments for various diseases have been the key drivers of drug spend in specialty, and offering access is a big goal for many retailers. Though the boom that accompanied many hepatitis drugs in the mid-aughts has subsided somewhat, drug firms continue to expand their pipelines.
Jill Regan, director of relationship management at Alpharetta, Ga.-based LexisNexis Risk Solutions, concurred. “Patients with serious chronic diseases and rare genetic conditions don’t simply pick up prescriptions with a wave and a nod,” she said. “Their pharmacists provide true personalized care based on patients’ condition and treatment plans, carefully reviewing and explaining proper administration, side effects and the regimen’s other demands and considerations in light of the patient’s overall health status.”
LexisNexis Risk Solutions leverages nonclinical data about patients for insights that help pharmacists better understand a patient’s health risk. Socioeconomic health scores are used to identify individuals who may require attention, helping pharmacy staff better allocate resources and address patient needs holistically. Regan said that pharmacists may inquire about finances, food security or transportation, then connect patients with resources to help solve challenges related to medication nonadherence.
Personalizing Patient Care
Aside from using technology, it is critical that retailers are prepared to manage the workload that specialty pharmacy care entails and understand the complexity of specialty medications.
For example, Publix Specialty Pharmacy has five departments. “Publix’s associates are committed to providing the necessary services that will ensure the patient promptly receives their medications with the appropriate support. These services include providing benefits investigation, prior authorization assistance, clinical support with a 24/7 on-call pharmacist, refill reminders, convenient pickup or delivery options, and educational videos,” Do said.
Ensuring Affordability, Safety
Helping patients afford specialty medications, which can carry hefty price tags that range from $1,000 a month to $10,000 a month, is yet another crucial responsibility for retailers in the specialty arena, and it requires a knowledgeable staff.
To help remove financial barriers to adherence, Amber, Thrifty White and Publix are proactive in helping patients reduce their out-of-pocket expenses by connecting them with copay assistance from manufacturers, access to grant and foundation money, and other resources.
“If a patient is diagnosed with cancer, the last thing they should have to worry about is ‘How am I going to pay for this?’ and the journey of working through insurance processes.”
Pharmaceutical firms also are doing their part to make specialty drugs more affordable.
There also is more competition in specialty from health systems and PBMs that have bought specialty mail order pharmacies, so it is imperative that specialty pharmacies continually innovate.
When it comes to innovation, Amber has been using artificial intelligence and machine learning to predict patients’ nonadherence. “We’re able to identify which patients are likely to have more challenges with adherence based on historical patterns, and proactively intervene on their behalf and enroll them in advanced adherence programs,” Wiese said.
Sandra Canally, founder and CEO of The Compliance Team, based in Spring House, Pa., which started accrediting specialty pharmacies in 2006, said that the company’s accreditation model for the specialty sector has changed “to incorporate key principles that guide today’s value-based care era with its emphasis on quality and positive outcomes.”
The company’s Patient-Centered Pharmacy Home accreditation program emphasizes improved patient medication management and care planning through better coordination between pharmacists and prescribers.
“The typical patient with chronic disease is by definition at high risk, and in need of this increased communication as well as better medication management to improve adherence which helps reduce ER visits, hospital readmissions, and lessen prescriber workloads,” Canally said.
As specialty continues to grow, Faulks said he would like all patients to receive the level of care that specialty patients do. “That would be the gold standard for pharmacy,” he said. “Although the economics don’t always allow that, we are making that shift, with better MTM reimbursement and more payer awareness of the services we can provide, we are moving to the ultimate goal.”