Specialty Pharmacies Improve Patient Outcomes, Minimize Costs to Health Care System
The goals of specialty pharmacy programs are to reduce or delay progression of the disease, improve patient outcomes, enhance patients’ quality of life, keep patients in the workforce longer, and decrease total health care costs.
As of January 2020, specialty drugs accounted for 39% of the total pharmacy benefit spend, which is expected to increase to almost 50% of total prescription spend by the end of the year. The specialty pharmacy industry is quickly expanding and its marketplace is expected to reach $400 billion in 2020.1
Currently, specialty medications are only used in approximately 1% to 2% of the population, but trends indicate that this utilization percentage will continue to rise. Seeing that high costs are associated with these medications and the magnitude of this increasing marketplace, it is important to examine what a specialty pharmacy is and the variety of important roles that it plays within this industry.
To begin, how do specialty medications differ from regular medications? There are many definitions of a specialty medication, but according to the Congressional Budget Office, “a specialty drug treats a chronic, complex, or rare condition and has at least 4 of the following 7 characteristics: cost at least $6000 per year in 2015; is initiated or maintained by a specialist; is administered by a health care professional; requires special handling in the supply chain; is associated with a patient payment-assistance program; is distributed through nontraditional channels, such as a specialty pharmacy; or requires monitoring or counseling.”3
A specialty pharmacy not only dispenses these specialty medications, but also provides a variety of enhanced pharmacy programs and services in addition to customized patient care. The disease states being treated in this population are often chronic, complex, or rare, as well as costly. Therefore, coordination, customization, and collaboration are vital in order to provide the best possible patient health outcomes.
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