Posted on November 14, 2019 in: Professional Practice
By Heba Sobh, Pharm.D., specialty pharmacist, AllianceRx Walgreens Prime, Canton
As we progress in the world of medicine and lean toward individualized health, the idea of specialty medications becomes more appealing. Specialty medications were first established in the 1970s as temperature-controlled medications to treat cancer, hemophilia, HIV and infertility.1 By the mid-1990s, there were less than 30 specialty drugs on the market. Today that number has increased more than 1,200% as there are over 500 specialty drugs spanning 40 therapeutic categories.2 This growth seems promising for many as new treatments are more focused on rare diseases and patients’ individual needs.
Generally speaking, medications are classified as specialty medications due to their high cost. Specialty medications are also those used to treat complex, chronic diseases and may require special handling and administration.3 The complexity associated with these medications may be attributed to the monitoring of side effects, the disease state being treated, limited access to the drug or financial barriers. Many of these medications also require special handling and storage conditions and, as a result, specialty medications are not commonly dispensed at a typical community pharmacy; rather, at a properly equipped specialty pharmacy.4
Specialty pharmacies require supplementary features to suitably store, handle and monitor these high-risk medications. To do so accurately and efficiently, specialty pharmacies may be divided into teams to provide the best care for patients. Each team handles a stage of that prescription and individuals from these teams may be grouped together to concentrate on disease states. Team tasks may be focused on intake and clarification of prescriptions, enrolling patients and scheduling mediation delivery, verifying insurance benefits, reviewing appropriateness of therapy, or even physically packaging the medication and supplies. These dedicated tasks allow for meticulous efforts to ensure a prescription is appropriately managed. Because of this comprehensive cycle, one can imagine that a specialty prescription is not processed as quickly as a non-specialty one at the local community pharmacy. This is important to explain to both patients and prescribers to ensure timeliness when ordering medications.
Specialty pharmacies have proactive standards in play to ensure medications are handled in a timely manner. In an ideal setting, all patients would receive their medications as scheduled without interruption in therapy; however, delays still occur due to unforeseen circumstances. These include unexpected weather conditions affecting delivery, necessary prescription clarification, prior authorization mismatch or even internal processing errors. In situations as such, teams work together diligently to warrant no further delay as many of these medications are time sensitive. Pharmacists are accountable for counseling these patients on missed doses, resuming therapy and monitoring. Additional clinical tasks for specialty pharmacists include drug dosing, drug interactions and patient education. Pharmacists work with prescribers to recommend alternative therapies after medications have been found ineffective or not listed on payer drug formularies. Pharmacists are also responsible for ensuring the specialty medications are compatible with patients’ concomitant non-specialty medications. As a result, specialty pharmacists must remain updated on non-specialty medications that may not be dispensed at their pharmacy.
Reports state that the growth in drug spending can be largely attributed to specialty medications.5 This can be expected as specialty medications, as previously mentioned, may be geared toward smaller populations or even individualized therapy. This focused therapy requires resources such as additional funding and knowledgeable specialists for research, production and monitoring. Pharmacists contribute to the safety and efficacy before, during and after medication approval. They provide hope to all patients, irrespective of their condition complexity or disease severity.
1. Cortez, M. and Lauerman, J. (2015). Valeant's Favorite Pharmacy Made Life Easy for Doctors, at a Price. [online] Bloomberg.com. Available at: https://www.bloomberg.com/news/articles/2015-11-12/pharmacies-like-philidor-make-life-easy-for-doctors-at-a-price [Accessed Oct. 19 2019].
2. Raper, A. (2019). The Rise of Specialty Medications: Hope for Patients, Hurdle for Health Care. [online] Covermymeds.com. Available at: https://www.covermymeds.com/main/insights/articles/the-rise-of-specialty-medications/ [Accessed Oct. 18 2019].
3. healthinsurance.org. (2019). What is a specialty Drug? [online] Available at: https://www.healthinsurance.org/glossary/specialty-drug/ [Accessed Oct. 14 2019].
4. Naspnet.org. (2016). NASP Definitions of Specialty Pharmacy and Specialty Medications. [online] http://naspnet.org/wp-content/uploads/2017/02/NASP-Defintions-final-2.16.pdf [Accessed Oct. 15 2019].
5. Bell, J. (2018). Drug spending growth to come solely from specialty meds, report says. [online] BioPharma Dive. Available at: https://www.biopharmadive.com/news/drug-spending-increase-2018-specialty-meds/519001/ [Accessed Oct. 18 2019].