Exploring Specialty Pharmacy: The new route for patient care
In 2012, spending on specialty medications totaled approximately $87 billion. By 2020, spending is projected to increase to $400 billion as pharmaceutical manufacturers reach for innovative and effective treatments for chronic conditions. With so much of the pharmacy business headed in the specialty direction, can you really afford to take a back-seat approach?
The number of patients requiring specialty treatment for disease states such as cancer, hepatitis c, rheumatoid arthritis, HIV, and more continues to increase, as does the need for pharmacies to supply drug treatments that provide optimal care for patients with chronic conditions. So why can’t traditional pharmacies dispense these drugs, and why would treatment for these patients be any different than traditional care?
Two primary differences are that specialty drugs often cost in excess of $6,000 per year—one hep C drug cost $84,000 for a 12-week course of treatment—and are available with limited distribution. Additionally, these treatments require a high-touch model of patient care that typical retail pharmacies don’t provide. In addition, due to the exorbitant cost of these medications, care providers must be able to document to both manufacturers and payers that patients are adhering to treatment plans and that the drugs are effective. Often, retail pharmacies lack the capabilities to provide this type of detailed authentication.
Due to the strict documentation requirements, however, the efficacy of many high-cost drugs is proven, and payers continue to reimburse for those that help patients. Do you want to be part of this innovative and growing model of care? Browse the checklist below to see if you are ready.
1. Accreditation: Many manufacturers and payers require your business to be accredited to ensure compliance and timely delivery of drugs to patients. Where does your business currently stand? (Some accreditation options include URAC, ACHC, and The Joint Commission.)
2. Training and Expertise: Your internal team must be well acquainted with treatments for the disease states that you want to manage. You could also develop training programs for these clinical areas.
3. Access to Medications: Analyze your current relationships with payers, prescribers, and manufacturers, and consider the locations you want to target to determine the particular medications you can access.
4. Technology Capabilities: You will need a sophisticated software application that can meet the complex reporting and data management needs of accrediting organizations, manufacturers, and payers.
5. High-Touch Patient Monitoring: Evaluate how you can alter your current processes to ensure quality clinical care and monitoring of patients, including routine adherence checks, outcome measurements, etc.
Use this quick reference list to start a conversation with your team about entering the specialty market. While getting into the marketplace can be difficult, our software equips you for the challenges, and professional consultants with expertise in the specialty pharmacy arena can help as well.