Q&A: Perspective from a Specialty Pharmacy Veteran

Author: Mark E. Paulson

Walgreens Specialty Pharmacy

Edward Finn, RPh

As a young pharmacy student at the University of Pittsburgh during the mid-1980s, Edward "Ned" Finn, RPh, had not heard of specialty pharmacy. No one had. Just 10 years later, he had already worked as part of a team to help develop one of the first specialty pharmacy automated distribution centers in the United States.

Today, Finn serves as vice president of specialty operations for Walgreens Specialty Pharmacy (WSP) and is responsible for operations in Pittsburgh, Pennsylvania, Ann Arbor, Michigan, Livingston, New Jersey, and Portland, Oregon. He has spent nearly his entire career as a pharmacist and pharmacy executive in specialty pharmacy since graduating in 1986. His perspective spans specialty pharmacy's past, present, and future. Below are his responses to several questions about specialty pharmacy.

Q: How do you define specialty pharmacy medications?

A: Specialty medications may be manufactured through biotech or traditional drug development processes. In the specialty pharmacy industry, the terms "biotech" and "specialty" are often used interchangeably. The term specialty medication refers to the category as a whole, whereas the term biotech medication refers specifically to those medications created through genetic manipulations such as recombinant DNA technology. As a result, use of these 2 terms varies.

Generally, these medications are expensive, with challenging dosing regimens and high side-effect profiles. These may be infused, injected, inhaled, or taken orally. Most of these drugs are used to treat life-changing diseases. Patients taking these drugs need a team approach to support the physical, as well as the financial, psychological, and social impact of the diseases and therapies used to treat these conditions.

Q: How did you begin your career in specialty pharmacy?

A: I knew I wanted to be a pharmacist before I was in high school. The pharmacists who owned the local independent drugstore were a big part of our community. My plan was to buy my own drugstore and become a key part of the community, too, and to help people. But, right about the time I was graduating, the business of pharmacy was changing, and the pharmacist-owned corner pharmacy was beginning to disappear. I still wanted to work as a retail pharmacist, so that is what I did for the first few years of my career.

Q: How did you find your way into what became specialty pharmacy?

A: Actually, what became specialty pharmacy began as a result of transplant operations being performed in Pittsburgh-area hospitals starting in 1988. Patients were coming from all over the country to have these procedures done. When patients went back home, their local pharmacies did not have easy access to the medications and had little knowledge of how to manage transplant therapies. Specialty pharmacy was born from this lack of access, along with the expense of these medications, the challenges that come from managing their administration, and coordinating the insurance benefit.

Q: What was it about specialty pharmacy that caught your interest?

A: In 1991, I joined the local Pittsburgh pharmacy that started a specialty pharmacy. It was really interesting. When I started, we were working with antirejection medications for transplant patients, and then we began working with HIV medications. Then, we became one of the first companies to have access to Crixivan, a blockbuster medication that was the first in a new class of cell protease inhibitors used in the treatment of HIV. In that first year of filling Crixivan prescriptions, the company went from generating revenues of $50 million per year to $300 million per year.

With that kind of growth, I realized that specialty pharmacy represented an incredible opportunity, and I was offered the chance to be a part of a team tasked with developing an automated distribution center. I have been in specialty pharmacy every since.

Q: What do you like about working in specialty pharmacy?

A: What I like best about specialty pharmacy is being able to help patients who have life-changing diseases, such as oncology patients and people who have multiple sclerosis, rheumatoid arthritis, hepatitis C, and other chronic illnesses. The specialty medications are expensive and can be difficult to administer, so there is much more of a challenge to the pharmacist to help a patient get the most from the treatment.

A lot of working with specialty pharmacy has to do with what we all went into pharmacy for in the first place: to help people feel better. Many of these medications have a complicated regimen—patients have to take these medications on a specific schedule on specific days, and it is not always easy to keep track of what to take on which day of the week. Also, we work with patients who had been very self-sufficient before their disease, and now they really need our help.

Q: What is the typical "day in the life" of a specialty pharmacist?

A: There really is no typical day for a specialty pharmacist. It is the very nature of specialty pharmacy that there is a lot of variety in a specialty pharmacist's day. Much of a specialty pharmacist's day is spent on the telephone. They will spend much of their time counseling patients regarding their medications. Or, they may be speaking with physicians regarding their patients and the medications that have been prescribed for them. They also may spend time on the phone with insurance companies, but many of the insurance issues are resolved by other members of the team who are experts in helping to coordinate patient benefits. And of course, a lot of time is spent filling and checking orders.

Education is key within a specialty pharmacy, so specialty pharmacists also may spend part of their day in a classroom, learning about emerging medications and therapies. Additionally, the specialty pharmacist will spend time at the front of the classroom, working with nurses and patient care coordinators to keep them informed on the latest specialty medications and therapies.

Q: And what would you say to pharmacy students about the future of specialty pharmacy?

A: First and foremost, I would tell them that the opportunities in specialty pharmacy are incredible, because of the explosive growth the field is experiencing. Ours is a growing part of the practice of medicine, and it will not be slowing down anytime soon.

There also are tremendous opportunities in the new technologies used in specialty pharmacy. Specialty pharmacy is conducted in a very clinical setting, and the new technologies we are using are found everywhere—in dispensing the medications, in the systems that we use to conduct and coordinate the treatments, and even in the call centers we use to stay in touch with our patients to make sure they are realizing the full benefit of the medications they are taking.

But most of all, working in specialty pharmacy provides an absolutely unique opportunity to assist patients who truly need our help. As a specialty pharmacist, you do much more than simply dispense medications. You are helping people who have developed life-changing diseases to live a better quality of life. That is what makes pharmacy a profession and not just a job.