What services do specialty pharmacies provide?
Specialty Pharmacy Services
Specialty pharmacy services are designed for a small, but growing population of patients with relatively complex and chronic diseases that require expensive and challenging drug regimens. Examples of such conditions include hemophilia, multiple sclerosis, HIV/AIDS, organ transplant, hepatitis C, infertility, growth hormone deficiency, Crohn’s disease, rheumatoid arthritis, and certain forms of cancer.
As soon as a specialty pharmacy receives a patient’s prescription, trained staff members schedule a consultation with the patient to discuss their treatment plan and make sure they are comfortable with all aspects of their care. This is the first of many opportunities for patients to ask questions, learn more about their therapies, and voice any concerns.
Specialty pharmacy staff stay in contact with patients throughout their treatment, making sure they get their medications and medical supplies quickly and accurately.
Access to Care Services
Specialty pharmacies offer a full range of clinical services to enhance the safety, quality, and affordability of care for patients receiving specialty medications, including:
- Health care provider access: Specially trained pharmacists, nurses, and clinicians are accessible to patients around the clock to provide guidance and insight on disease states, as well as the use and management of specialty drugs.
- Physician consultations: Consults directly with physicians to address patient side effects, adverse drug reactions, non-adherence, and other patient concerns.
- Care management: Performs disease and drug-specific patient care management services that meet the unique needs of each patient and incorporate multiple safeguards when dispensing and delivering the drug to ensure patient safety.
Clinical Outcome Services
Additional clinical services specialty pharmacies offer to enhance the safety, quality, and affordability of patient care include:
- Clinical outcome measures: Collects data and tracks outcomes for specific patients.
- Patient adherence programs: Manages patient adherence and persistency of drug regimens.
- REMS programs: Manages care for manufacturer Risk Evaluation and Mitigation Strategies (REMS) program requirements, including REMS reporting, Phase IV trials, the dispensing of FDA trial drugs under strict protocols, and related clinical and cognitive counseling.
Drug Affordability Services
Operational services provided by specialty pharmacies to help facilitate solutions for patients, while not compromising their quality of care and aligning with payer specialty benefit design, include:
- Insurance navigation: Expedites access to therapy by working directly with insurers and navigating their benefits, utilization management, and prior authorization processes. Helps patients whose treatments become a financial burden by working directly with insurers and exploring every option available to patients.
- Patient assistance: Facilitates eligible patients’ enrollment in patient assistance programs and access to charitable resources.
- Plan optimization: Aligns economic incentives across medical and pharmacy benefits while helping patients navigate the complexity of sometimes-siloed benefit structures.
Additional operational services provided by specialty pharmacies include:
- Supply chain management: Adheres to rigorous storage, shipping, and handling standards to meet product label shipping requirements, such as temperature control and timely delivery of products in optimal conditions.
- Collaboration with patients’ physicians: Interacts regularly with patients’ physician’s offices. Pharmacy staff keep physicians informed of patient progress, letting them know if patients are facing difficulties with their treatment or are experiencing undesirable side effects.
- Logistical coordination: Offers coordinating services with other health care providers, including those providing skilled nursing services, custodial care, infusion administration, and direct-to-physician distribution.
- Convenient delivery: Services to provide patients with fast delivery of their medications to their location of choice.
Resources & References
- Specialty drugs and pharmacies, Report 355. National Center for Policy Analysis. May 22, 2014.
- Managing Specialty Medication Services Through a Specialty Pharmacy Program: The Case of Oral Renal Transplant Immunosuppressant Medications. Journal of Managed Care Pharmacy. January 2013.
- Mail-Service and Specialty Pharmacies Will Save More than $300 Billion for Consumers, Employers, and Other Payers Over the Next 10 Years. Visante. 2014.
- Aetna: Condition Specific Support. Aetna Specialty Pharmacy. 2015.
- BriovaRx Pharmacy Services. BriovaRx. 2015.
- Cigna Specialty Pharmacy Services. Cigna. 2015.
- White Paper: The Management of Specialty Drugs. sPCMA. February 2016.