The velocity of growth in the specialty pharmacy field presents challenges to both academia and industry leaders as we examine our readiness.
Specialty pharmacy is on an evolutionary fast track and will grow to consume greater than 60% of the total US payer drug spend by 2013—the pharmacy and medical benefit combined. Disease states will continue to expand as new life-saving products come into the market, and more patients will require highly-trained medical professionals. As a result, the demand for uniquely qualified specialty pharmacists will intensify.
The velocity of such growth presents special challenges to employers such as managed care providers, industry, and highly-focused pharmacy operations that may be seeking pharmacists who not only understand the drug and disease aspects of specialty pharmacy practice, but also how this market sector differs from other pharmacy practice settings.
Current Specialty Pharmacy is Limited
Today, there is limited coursework and practice settings (rotations) specifically on specialty pharmacy being offered in schools of pharmacy or through other accredited bodies. Interviews with some of the country’s top pharmacy school educators indicate that, while they have an eye on this emerging practice setting, their core curriculum continues to be focused on a “generalist” training that broadly prepares their students for serving the largest segments of the population. Pharmacy schools do an exceptional job of academically preparing pharmacists but are challenged by the rapidly growing volume of drug and medical information that must be communicated in preparing students for the real world of specialty practice. Some schools have expanded their curricula to meet the information demand using enhanced technologies such as online databases, networked PDAs/iPads tied to specialized software. Even with additional courses and content, schools have not been able yet to make specialty pharmacy a fully integrated part of their educational programs, short of expanding the curriculum beyond the present 6-year programs leading to a PharmD.
In a nonscientific survey of specialty pharmacists from several different pharmacy schools, all reported that none of their academic or experiential training prepared them for the actual practice of specialty pharmacy as it exists today. Even those conditions and drugs that are frequently encountered by a specialty pharmacist (such as multiple sclerosis, rheumatoid arthritis, hepatitis C, and so on) were only briefly taught in pharmacy school. Further, all of the pharmacists reported that the concept of specialty pharmacy as a practice setting was not mentioned during coursework. Internships and experiential training with specialty pharmacies were of great value in learning about this practice setting, but these opportunities have not been widely available to pharmacy students. Perhaps leaders in specialty pharmacy should consider offering rotations to nearby pharmacy schools. Students can be an excellent resource to specialty operations, including taking on tasks for the operation, adding to their efficiency.
Understandably, pharmacy schools are responsible for providing society with professionals who can care for the most prevalent conditions, offering the greatest good to the broadest population. However, these schools recognize it is their role to continue to improve what they teach, and how they teach it, as the field pharmacy evolves along with the larger health care system.
As mentioned before, the greatest area of growth is specialty products—and to educate the next generation of pharmacists. Academia and specialty pharmacy practice must take on greater responsibility, or else our pharmacists will be obsolete prior to entering practice.
On the Front Lines of the Cost Debate
As the United States struggles with the overall cost of health care, pharmacists are on the front lines of balancing the demand for costly specialty pharmaceuticals by small patient populations with the larger societal call for more affordable medications. Specialty pharmacy, therefore, is a logical part of the educational preparation that new pharmacists should receive. As evidenced by government and private payer concerns about the diseases and treatments that fall under the specialty pharmacy “umbrella,” a very clear shift of focus has occurred and will only continue to increase. Specialty pharmacy has the ability to optimize patient care with these high cost products and provide optimal outcomes. In the absence of quality pharmaceutical care, costs run the risk of going up.
Systems vs. Disease Approach—A Better Educational Model?
While many schools of pharmacy gain insights from business sector advisory groups, it is unlikely that a unique specialty pharmacy curriculum can or will be developed and implemented as a short-term priority. However, instituting a systems approach (eg, managed care, hospital, home care, long-term care, radiopharmaceutical, and specialty) versus a drug and disease approach might help bridge the educational gap. Other creative concepts mentioned by pharmacy schools include optional specialty pharmacy educational tracks, residencies, post-graduation specialized training, survey courses, and “tool kits” that can all prepare pharmacists for specialty pharmacy practice.
A collaborative educational process can be developed if academia and specialty pharmacy align around a set of electives whereby students can opt-in to courses and practical experiences around specialty practice. An informal survey of specialty pharmacy peers validates that specialty pharmacy is ready to provide the resources—if academia can wrap around the real world setting of specialty practice.
Currently, most specialty pharmacy training happens on the job, although some experiential programs exist as feeder programs for PBMs and other companies. A more strategic approach would follow traditional pharmacy training, leading to a more prepared and expert specialty pharmacy workforce.
Specialty pharmacy, and its growing importance to society and health economics, offers an exciting career opportunity for pharmacists. To ensure the best possible educational and practice outcomes, our profession must examine its readiness as the specialty stampede heads its way. SPT
Randell J. Correia, PharmD, is a senior vice president of Prescription Solutions by OptumRx, an innovative pharmacy benefit management organization managing the prescription drug benefit of commercial, Medicare, and other governmental health plans, as well as those of employers and unions. One of the Optum companies of UnitedHealth Group, Prescription Solutions serves members through a national network of 64,000 community pharmacies and state-of-the-art mail service pharmacies in Carlsbad, California, and Overland Park, Kansas. Dr. Correia is responsible for the mail service and specialty pharmacy business lines, which serve more than 200 clients and 13 million mail service covered lives and more than 180 clients and 22 million specialty pharmacy covered lives, respectively, with a service area spanning the entire United States and territories.