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03/13/2013

What’s So Special About Specialty Pharmacy?

Released earlier this month, the 2012 Drug Trend Report by Express Scripts highlights the decrease in spending of traditional drugs by Americans. Notably, this decrease was offset by an 18.4% increase in the total spending for specialty drugs. As it varies based on patient need, specialty drugs can be defined as those that treat a complex disease state or require a more complex route of administration (i.e. intravenous). With specialty drugs making such a profound increase in costs, it is important to understand their special place in the market.

Following the profound importance of specialty drugs, there has been a subsequent increase in specialty pharmacies. Specialty pharmacies such as Burman’s and Walgreens focus on specific disease states like Hepatitis C, HIV, and Cancer and as a result, have specialty medications more readily available than the traditional community pharmacy. Additionally, specialty pharmacies possess the resources to tailor their services as necessitated by the patient’s condition, which can thereby improve medication adherence.

From a clinical standpoint, specialty pharmacy is especially enticing in its capacity to collaborate with other health care professionals to make optimal treatment interventions in addition to facilitating adherence. As evidenced by Fairview Specialty Pharmacy in conjunction with the University of Minnesota Medical Center, a multi-disciplinary team approach coupled with effective communication can synergistically improve adherence. In this instance, Fairview was able to work with providers to optimize the management of specialty drugs that treat Hepatitis C. According to the Centers for Disease Control, 3.2 million people are chronically infected with the virus. If that wasn’t enough, the drug costs associated with Hepatitis C increased by 33.7% in 2012. With such significant drugs costs on the rise, it is crucial that patients remain adherent to these medications. In a patient with a condition as serious as Hepatitis C, failure to take medications as prescribed puts them at an increased risk of not only costly hospitalizations, but also resistance to future drug therapy regimens which leads to even greater medical costs and potential for treatment failure. By avoiding this, we can see the potential of incorporating a specialty pharmacy. Research has shown that Hepatitis C patients who only used a specialty pharmacy had about an 8.6% increase in adherence as well as a 60% higher likelihood of achieving optimum adherence as opposed to those who used a retail pharmacy.

Thus far, specialty pharmacy has been making its mark. By focusing on conditions with intensive therapy regimens while giving managed care organizations the added benefit of consistent follow-up to ensure better patient adherence, third party providers have been able to cut costs. With its notable benefits from a clinical and financial standpoint, it is expected that specialty pharmacy will further develop as an increasing number of specialty drugs come out of the pipeline.

Anita A. Pothen, PharmD ‘14

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My apologies. my computer decided to send the message before I did.

To continue,

some operations base the specialty drug classification "on cost tiers where agents costing more than a certain amount
(e.g., > $500, $1000, $1500, etc.)." It is unclear to me how this focus on product cost benifits the patients. I would suggest that in fact such a system simply makes a challenging thing harder by adding another layer of complexity to an already complex system. More calls to differnt numbers, more emails to differnt places, more explanations to more people and more hoops for the prescirber to jump through - all results of such a system.
I don't doubt it can be done "right," but I would suggest that "right" is not always the driving force. Too often the motivation can be profit despite claims that its not about the money. Sadly I find that even when its not about "the money", its really about the money.

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