A consistent topic at recent pharmaceutical events is the dramatic growth in specialty Pharmacy. Specialty pharmacy drugs are typically very high cost, complex therapies used to treat chronic disease states such as hemophilia, cancer, transplants, multiple sclerosis, among others. These therapies also require a significant need to respond to more intense patient needs. Finding a way to meet patient needs and balance cost is the challenge facing all partners in the healthcare supply chain.
Major drug companies are spending a larger portion of their research and development money in specialty pharmacy. This shift is driven by emerging technology which enables the creation of drugs that are designed to be more patient-specific based on patient genetic makeup. These unique therapies offer the potential for higher revenue and margin for pharmaceutical manufacturers and can also be less vulnerable to expiring patents compared to traditional drugs.
Retail pharmacies are looking for opportunities to diversify their businesses and are making the case for adding specialty pharmacy to their services. Specialty pharmacy can be enticing to retail pharmacies and the need to have a presence in this space is critical for retailers. However, the transition to specialty pharmacy is not without challenges. The complexity of billing and reimbursement creates significant challenges and risks to pharmacies entering the specialty pharmacy market place. In addition, the need to manage patients to ensure therapy adherence and help them with significant adverse events while maintaining compliance with FDA mandated REMS (Risk Evaluation Mitigation Strategies) programs is critical to success.
“Increased ability to use genomics in to drive effective therapies allows treatments to be much more targeted,” according to Ned Finn, vice president of Inmar Healthcare Network. Adding, “Specialty pharmacy is complicated and expensive, and a significant portion of the drugs must be injected or infused by a medical professional. Optimizing therapy and helping provide the most cost effective site for care can help health plans improve patient outcomes at a lower net cost to their plan sponsors.”
Another area to consider in specialty pharmacy is the handling of returns. Many of these drugs require controlled temperature storage. With limited shelf life and storage capabilities, the potential for an increase in returns must be considered. Both manufacturers and retailers have to keep a close eye on these products and retailers, in particular, must understand the manufacturers’ policies regarding credits.
Specialty pharmacy is one of the many industry trends challenging our clients in the highly regulated and complex area of healthcare management. With specialty pharmacy gaining more attention in the marketplace, we are exploring ways to help our clients who are interested in adapting their businesses to accommodate this trend.