Commentary: Where Old Meets New?Specialty Pharmaceuticals and Community Pharmacy

Author: Douglas Hoey, RPh, MBA


Mr. Hoey is the senior vice president and chief operating officer of the National Community Pharmacists Association.


It makes for an interesting juxtaposition—the neighborhood pharmacy, the centerpiece of Main Street working closely with cutting edge, almost futuristic health care technology customized for the specific needs of a patient's condition and lifestyle. This is one way to describe the interrelationship between community pharmacy and specialty products, and it is the future. Community pharmacists are well positioned if they choose to take advantage.

There are varying definitions of what denotes a specialty drug, but most agree that they are expensive, require special storage, dosing, or administration, and often have complex side effect profiles.

Market Growth

The use of specialty pharmaceuticals is increasing rapidly. A couple of factors are contributing to the growth. Research is revealing more about rare diseases, and as a result, more specialty pharmaceuticals for specific conditions are being developed. Another factor is that breakthroughs with oral, solid, receptor modifying drugs seemed to have reached their peak in the 1990s, and many of these products are, or will become, available generically within the next few years. Generic dispensing rates are higher than they have ever been and are expected to climb even higher, leading many manufacturers to adopt new business strategies emphasizing specialty pharmaceuticals.

The expansion of specialty pharmaceuticals has not only resulted in higher prescription volume, but also higher revenue. In 2004, specialty pharmaceuticals accounted for 23% of all pharmaceutical expenditures. By the end of 2008, specialty drugs were expected to account for 35% of all pharmaceutical expenditures. Obviously, the growth in specialty pharmaceuticals is far outpacing the rest of the marketplace.

A Reputation for Patient Service

The unique requirements and the cuttingedge growth of specialty pharmaceuticals create a perfect storm of opportunity for community pharmacists. The calling card for community pharmacists is providing services for the patients in their community. Numerous surveys, including Consumer Reports and the WilsonRx Pharmacy Satisfaction Survey, have shown that community pharmacists are top-ranked in providing patient service-the kind of service that translates well into providing care for patients taking specialty medications.

The strong revenue growth in specialty pharmaceuticals also has been noticed by others, such as pharmacy benefit managers (PBMs), publicly traded chain drugstores, and payers. The giant PBMs have acquired market share by purchasing specialty pharmacies that allow them to self-refer specialty patients to their mail order factories where they can leverage manufacturers for higher rebates and restrict networks that funnel specialty patients to their operation. Some chain drugstores have followed suit and also are acquiring specialty pharmacies. Additionally, some research manufacturers—especially those with medications treating orphan or ultra-orphan conditions—restrict which pharmacies are allowed to dispense their product.

Despite these obstacles, community pharmacists are uniquely positioned to grow their specialty business. From a productivity and expense point of view, employers are motivated to make sure their employees are receiving maximum benefit from their specialty therapy. Community pharmacists are well positioned to address this need by providing the customized care that this patient population requires. Additionally, care for these patients often requires nimbleness in the counseling, billing, storage, and delivery of the medication that is well suited for entrepreneurial community pharmacists.

Growth in the specialty marketplace will require some adjustments and plenty of flexibility with the business model for many community pharmacists, but the opportunity is there to combine advances in technology and new drug discoveries with the familiar hometown touch upon which community pharmacists have built their success.