Independent community pharmacists are well positioned to aid patients with specialty medications.
I strongly believe independent community pharmacists are best suited to help patients optimize the use of specialty drugs or biologics that treat diseases—from cancer to arthritis—with such drugs as Humira, Enbrel, Remicade, Avastin, and Rituxan. You might ask what justifies such a declaration.
Specialty medications are enormous investments for the health plan that pays for them and for the patient who takes them. These medications often require special storage, special administration, special handling, and special counseling to ensure adherence to these pharmaceuticals and manage their sometimes very potent side effects. Who better than a community pharmacist to serve these special patient and payer needs?
However, for years, financially aggressive pharmacy benefit managers (PBMs) have exploited their ability to dictate the definition of what is considered a specialty drug to create another profitable revenue stream and send these high-touch medications to a mailbox!
PBMs that own mail order pharmacies have utilized their managed prescription formularies to liberally label one product after another as a specialty drug. Once that designation is made, the PBM can dictate that patients acquire the specialty drug exclusively through the mail order pharmacy it owns. With the consolidation and acquisitions occurring in that industry, such profiteering will likely only grow worse.
Looking at the trend line for specialty drugs, the stakes become clear. Around the middle of this decade, specialty drugs will account for 40 to 45 percent of pharmaceutical manufacturer sales and will comprise 7 of the top 10 best-selling drugs. If the current rate of mandatory mail order requirements for specialty drugs continues or accelerates under the current PBM business model, PBM profits will grow even more. But it will be unpopular with patients and I predict it will prove costly for employers, taxpayers, and other health plan sponsors.
At the National Community Pharmacists Association (NCPA), we are working on this mostly at the state level where each respective legislature has been or soon will be tasked with creating a more concrete definition of specialty drugs that creates an environment that is financially feasible for broad participation and not easily exploited by PBMs.
Recently, we have worked with our allies in several states to create specialty drug definitions that allow independent community pharmacies to compete. We are also focused like a laser on early 2013 when many state legislatures will be back in session, and tweaks to existing legislation and/or the introduction of new legislation will become possible. Working with our allies, NCPA has created a preliminary draft for a model definition.
At the federal level, NCPA is raising awareness about the current specialty drug dynamic and pushing for a more uniform national standard in Congress. In addition, NCPA is pursuing the specialty drug claim that was upheld in the recent legal complaint by the National Association of Chain Drug Stores (NACDS) and NCPA against the ESI-Medco merger.
So, an obvious question is how to best prepare for the growth of specialty drugs and services to your patients. First, examine the medical needs of patients in your community to determine if you can fill a current void for specialty drugs. Second, if necessary, sharpen your knowledge about the disease state in which you are specializing. Third, consider how you are currently and how you will collect data about the services you are offering specialty patients. Fourth, utilize or develop a medication adherence program. NCPA offers the Simplify My Meds program free to all members (www.simplifymymeds.com). Fifth, come up with a marketing plan for health plan sponsors and patients so they are aware of the specialty drugs and accompanying services your pharmacy will be offering.
Independent community pharmacies should provide more and more niche services in order to remain competitive and enhance their viability. If incorporated properly, specialty drugs can become part of that equation and eventually their market size will dictate they become much more than a niche. Moreover, utilizing community pharmacists to help maximize the benefits of specialty drugs can be a win for patients, a win for health plan sponsors, and a win for pharmacists.
Let’s not let PBMs decide who controls this terrain.
B. Douglas Hoey is the chief executive officer of the National Community Pharmacists Association. He has spent more than 20 years working in and representing community pharmacies.