Patients taking specialty medications face a wide range of challenges, including how to access their medication and where to turn for support. Think about someone with a complex condition starting on a medication.

The first time they need to get the medication filled, they may wonder how to start on a treatment regimen they need to inject. They may have an established relationship with their local pharmacist, but the community pharmacy is unable to help with the clinical and financial aspects of their specialty drug.

People with specialty conditions may have a preference for the community pharmacy where they have been going for years, having established great relationships with the pharmacist and staff. As such, they don’t want to lose that personal connection by having to move to specialty mail order.

Other people may not be able to take a day off work to wait for the medication to be delivered to their home or otherwise disrupt their life every month to wait for a specialty product at home. Others may face logistical challenges if they live or work in multiple locations. 

For example, snowbirds who spend half the year in Florida and the other half of the year in Pennsylvania worry about how they’ll get their medication when they are in another state. Today more than ever, people are on the go and may travel for business, taking them away from home for extended periods of time. When schedules get hectic, it makes it difficult for people to refill their medication and stay adherent to therapy.

Some patients may attempt to fill their specialty medications at a traditional retail pharmacy; however, many community pharmacies may not be equipped to fill these therapies. Retail pharmacies can currently dispense some specialty medications. But simply dispensing the medication is not the same as providing the experience and high-touch clinical support to specialty patients, regardless of where they choose to drop off or pick up their prescription.

Specialty pharmacies can provide seamless support across specialty mail and retail channels. Additionally, there are a significant amount of limited distribution specialty medications and retail pharmacies are frequently not part of the limited distribution network.  

Furthermore, specialty pharmacies provide a number of high-touch services. Patients filling specialty prescriptions at retail pharmacies may not receive insurance guidance, financial assistance, and clinical support equal to the services provided through knowledgeable specialty pharmacy providers.

Other limitations at retail include cold chain storage requirements as well as risk evaluation and mitigation strategy (REMS) requirements unable to be met. REMS programs allow the manufacturer to market a risky drug, but to do so with restrictions.

For pharmacists, the restrictions on who may dispense and administer a REMS drug may be challenging in a retail setting if that REMS program requires pharmacies or other health care settings to become certified to dispense the REMS medication. Individual pharmacists may be required to complete training, verify safe use conditions (eg, verifying required laboratory monitoring or that a patient or prescriber is enrolled in the REMS), counsel patients, and/or provide educational materials or a medication guide.

Retail pharmacy staff is not usually trained on specialty conditions or medications. Pharmacists who work in specialty disease states, such as transplant, cancer, inflammatory conditions, or rare genetic diseases are trained to be experts on complex drug therapy regimens that usually require closer involvement with patient and providers.
 
Yet retailers and community pharmacies have established relationships with their patients. What if patients could have the best of both worlds? Consider a system in which their community pharmacy offered patients the ability to maintain their relationships with their trusted local pharmacist and also allowed for a channel to pick up and drop off their specialty medication but provide the patient with clinical expertise through their specialty pharmacy channel. This option does exist today with some of the large chain retailers. 

Patients using community pharmacies such as CVS (CVSHealth) have access to their specialty drugs at the retail stores, as well as full access to the specialty pharmacy care teams. Patients can receive the same holistic approach to care regardless of the intake channel they come in through or which medication delivery option they choose.

Here’s how it generally works: the community or specialty pharmacy may receive specialty prescriptions via fax, e-prescription, phone, or in person (at the retail pharmacy only). Patients can drop off or pick up their specialty prescriptions at a retail location.

All patients, regardless of how they initiated their prescription, have the option of where they would like their prescription delivered at a local community store, home, physician’s office, or an additional location of their choice. The dispensing of the drug, drug utilization review, and clinical management, such as prior authorizations (PAs), occurs at the specialty pharmacy and helps provide a consistent specialty experience for all patients, regardless of channel. 

The benefit is that all specialty prescriptions that initiate at retail will receive the same level of clinically appropriate support as they do with a specialty mail patient today. Specialty patients benefit from a specialty retail offering with greater access and expanded choice at every point of their specialty medication fulfillment, including intake, pick up, delivery, and payment.

Patients can benefit from receiving the same clinical support from clinicians with expertise in the condition, whether using retail pick up or specialty mail delivery services. Patients can lessen their concern about being home when a shipment arrives.

An alternative now exists for patients with non-specialty comorbidities who prefer the convenience of retail drop off or pick up or value their relationship with their local retail pharmacist. Access to this channel also simplifies prescription coordination for patients by allowing them to pick up or receive their medications—specialty and non-specialty—in a convenient location.

Retail provides flexibility for patients who may be traveling, snowbirds, students, and caregivers. And most importantly, patients will continue to receive all the high-touch, services and outreach to provide education, monitoring, and support tailored to their condition and individual needs through the specialty pharmacy.

Not only do patients benefit from a retail pharmacy channel for their specialty medication, but so do physician offices and prescribers. Specialty dispensing at retail helps make sure the process is as efficient as possible for physician offices so that they can focus on their patients, not administrative tasks such as PAs and benefit verification. 

For prescribers, this streamlines the referral process. The prescriber can follow the usual process when sending a referral to the specialty pharmacy; however, if a prescriber chooses to send the referral through the retail channel, they can phone, fax, or e‑prescribe the referral to a participating retail pharmacy location or the patient can take the prescription to a retail pharmacy.

No enrollment forms are required to get started, further enhancing the experience. Other benefits to physicians include reinforced patient adherence to the physician’s plan of care by providing access and convenience to the patient, by leveraging the established retail pharmacist relationship and routine store visits. 

Physicians can have the confidence that their patients will not be turned away at a retail pharmacy and will instead receive the care and support they require. Expanding patient access helps physicians’ offices to better support their patients’ needs by providing a choice of delivery location, which is highly valued and can meet the needs of a wide range of patients.

Since specialty medications and conditions are complex and require a high level of care, patients have the best outcomes when they are supported by teams with experience in specialty care.  

Successful retail and specialty collaboration require specialized training of retail and specialty pharmacy staff on a broad, system-wide basis. It’s important that no matter how the patient submits a prescription, the patient will receive a consistent experience supported by clinicians with expertise in their condition. 

There also needs to be system integration that prompts alerts when a specialty medication is entered so that the specialty patient is identified and counseled by a pharmacist before being connected with a specialty pharmacy care team. The system integration should ideally allow a full view of the patient regardless of location or type of pharmacy.  

Additionally, there should be consistent, comprehensive counseling by the specialty care team to the patient before release of the specialty medication to have greater oversight of when to expect delivery of the medication. And lastly, universal access across every retail location (except for the states with restrictions) should be provided, rather than selective locations so a patient can use any of the community pharmacy locations.

There are some limitations to specialty drugs through a retail channel offering like this.  Certain individual drugs may need to be excluded if they have a high potential for off-label use, such as the pulmonary arterial hypertension drug sildenafil, which may be used off label for erectile dysfunction.

Some states may have restrictions on allowing patients to pick up specialty drugs at retail locations and those states would not be a good fit for this offering. In that case, the specialty pharmacy is the best channel to use.

Specialty patients are faced with complex conditions, often with non-specialty drug comorbidities, and they require a high level of care and support to manage their conditions. By providing convenient access to medication, paired with a high-touch approach to patient care, more effective engagement can take place along the continuum of care.  

Beyond the traditional specialty pharmacy, combining the best of both worlds—retail pharmacy and specialty pharmacy—has the potential to improve health care outcomes and lower costs while creating value for both the patients and providers.   

 About the Author
Brandeis Seymore, RPh, earned her Bachelor of Science Pharmacy degree from the Duquesne University School of Pharmacy and is currently enrolled in the Master of Pharmacy Business Administration (MPBA) program at the University of Pittsburgh, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines.  She has spent the past several years working as a senior clinical manager assisting employers with their pharmacy benefit management strategy.  Prior to these experiences, she has held roles of increasing responsibility, most recently as a Strategic Account Executive to support client’s marketplace needs and demands.