Maybe we’ve been thinking about this all wrong. For more than a decade, pharmacy providers have been exploring and chasing the concept of specialty at retail as a conduit to engage patients and dispense designated specialty medications to the patients within regional reach.  
 
This has been driven by interest from all niches within the pharmacy marketplace. The captivating characteristics of the concept of specialty at retail includes the potential for participants to unlock vast financial, contracted volume, and patient continuum of care opportunities attached to the pharmaceutical products found in current specialty pharmacy environments.  
 
Pharmacy chains both regional and national, independent pharmacies, specialty pharmacies, payer-owned mail order pharmacies, large retailer owned systems, and grocery store pharmacies have all had their eye on this prize, each attempting—from their own perspective and frame of reference—to design and deploy an offering viable in today’s market. However, none have truly found a sound and reproducible model that proves value beyond that of creating designated pick up locations.  
 
Why have retail pharmacies, each equipped with a clinically-trained pharmacist and vast investments in automation and technology, been unable to embrace and implement the concept of specialty at retail? Is it possible that the equation is being solved in reverse, and simply by flipping the paradigm, could true localized delivery and support of specialty pharmaceuticals and associated disease states be achieved? Is it possible that our industry should be creating retail at specialty?
           
One of the defining characteristics of retail pharmacy is the technology and workflow that support the management of inventory and prescription documentation. Most of the existing technology that is found was designed to handle high, rapid volume with little to zero capabilities dedicated to true patient care or disease management functions.  
 
Without even exploring high touch patient care algorithms, the architecture of the pharmacy experience within the framework of retail pharmacy systems was designed to organize prescription information, coordinate payment for prescription medications, prevent diversion or misuse of controlled substances, and manage local inventory requirements. It was not designed to drive outcomes, enhance persistence, ensure adherence, or even align multiple channels of care.  
 
This lack of empowerment by dedicated technology is a primary barrier to realizing specialty at retail initiatives effectively. The currently employed workarounds to even attempt honest patient care efforts are inconsistent and highly manual with little system integration to permit the vital reporting and data aggregation activities that prove value and enhance profit streams.
           
There are other barriers to the realization of specialty at retail though. If we pay attention to the facets of specialty pharmacy practice in which dedicated specialty pharmacy providers excel, then the gaps in capability and processes become evident.  
 
Specialized product handling, focused patient counseling and support, adverse event collection, process standardization, quality assurance initiatives, patient financial support efforts, enhanced clinical data management, extended payer interaction support and documentation, prescriber or office care initiatives, and enhanced data management functions are all examples of the strategies in which specialty pharmacy providers excel.
 
Due to the commoditized nature of retail pharmacy, there has been little adoption or enhancement of any of these activities within the current retail pharmacy environment, permitting an ever widening gap in the possibility of a true specialty at retail model. While retail pharmacies often assist patients in the use of co-pay cards when presented, few connect patients proactively with co-pay assistance programs or foundational assistance to ensure prescribed care is obtained.  

At best, simple and general cold chain storage is embraced, while any advanced cold chain storage or delivery models continue to be lacking in the retail setting. Patient counseling is approached with generalist efforts and often prompted only with triggered CMRs or payer identified interventions.  
 
Prior authorization efforts are left to the discretion of the prescriber’s office and little is done to facilitate authorization efforts by the retail pharmacy. In essence, a retail pharmacy would be required to adopt new and disruptive activities requiring employee bandwidth or technology support that does not currently exist without extensive investment of time, funds, and training.
           
But could specialty pharmacy providers effectively deploy a retail experience if they were built as localized offices of patient care efforts?  The possibility is compelling.  
 
A couple of major retailers, including Walgreens, have embraced this concept and have begun to open small, specialty pharmacy storefronts with the systems, training, and back end operational support to provide high touch patient care programs while aligning the high volume maintenance prescriptions representative of chronic conditions with a low level of acute needs.  
 
Essentially, the focus on the management of the patient with a disease state requiring high touch therapy is central to the workflow. Technology and systems utilized to drive specialty pharmacy providers can also handle effectively, through automation and central fill support, the remaining prescription profile of such a patient.  
 
By embracing the utility of call centers and integrated care solutions, these retail at specialty pharmacies could effectively communicate with patients and drive intended outcomes surrounding chronic care scenarios of even commonplace disease states. The concept of designing and deploying retail pharmacies that have the internal capabilities of specialty pharmacy providers offers untapped potential.  
 
It means to not simply provide specialty pharmaceutical products and care in community settings, but to reinvent the practice of retail pharmacy as it is known today. By infusing novel technology solutions, this concept holds the potential of retooling the retail experience and resetting expectations by truly offering enhanced care where needed the most. 
 
Retail at specialty could reset the benchmark of value that can be achieved in genuine patient care initiatives. Retail at specialty: maybe it’s time we take a new look at an old quest.
 
About the Author
Heather Brand earned her BA in Chemistry and PharmD from the University at Buffalo, SUNY. She worked for an oncology based pharmacy for 6 years prior to transitioning to a consultant role for a benefits management firm. She is currently employed by Onco360 pharmacy as a Clinical Oncology Pharmacist and has just completed her Masters of Science in Pharmacy Business Administration (MSPBA), a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines at the University of Pittsburgh.