Commentary: Specialty Pharmacy Helps Promote Patient Adherence

JANUARY 01, 2009
Michael A. Nameth, RPh, MBA

Michael A. Nameth, RPh, MBA
Mr. Nameth is executive vice president of Walgreens Health Services.

Patient adherence is a key focus for specialty pharmacy providers. Physicians prescribe specialty medications to treat complex diseases that may present challenges to patients. The best way to make sure that patients experience the optimal outcome is to help ensure their adherence to the prescribed regimen.

A fundamental element to achieving patient adherence is for the pharmacy to administer a complete educational care program prior to and during the course of therapy. Specialty pharmacists and the specialty pharmacy care team can promote better patient adherence because of the high-touch/high-tech approach to helping their patients, families, and caregivers understand the often complicated realities of a specialty medication treatment plan.

Both community and specialty pharmacists face a number of factors that can lead to decreased patient adherence, including medication side effects, dosing schedule, and cost. These same factors are magnified in the case of a specialty medication regimen, as the medications themselves can be more toxic, the side effects are often much more exaggerated, and the cost of specialty medications is, on average, 10 to 15 times more expensive. Because specialty medications are typically either injected or infused, patients must either have self-injection training, or they must schedule the medication's administration by a medical professional at a care site.

Patient care programs are developed by clinicians and are designed specifically for specialty disease states and their treatments. Because of their specialized training, knowledge, and experience, members of the specialty pharmacy care team are uniquely positioned to offer the high-touch, high-care level of patient education and added-value service to patients and their caregivers that ultimately will enhance patient adherence and outcomes. Patients will begin therapy with an educational foundation that prepares them and sets expectations for the treatment.

The team of specialty pharmacists and other specially trained care team members is in close contact with the patient. This contact allows the patient to feel more confident in the level of care and attention he or she is receiving and therefore much more able to maintain the course of treatment prescribed. Not only does this improved adherence benefit the patient, but also the patient's family, employer, and the employer's insurance carrier as well. The health care insurer benefits from a reduction in total medical costs for the patient and improved satisfaction. The patient's employer gains from increased productivity at work. The patient also should experience an improvement in his or her quality of life at home and at work.

This effective, patient-focused team approach to pharmacy offers a number of lessons for the practice of pharmacy as well. The specialty pharmacist must execute multiple layers of a care plan when dispensing medications while interacting directly with the patient to assess efficacy of the therapy and to offer guidance. The specialty pharmacy team is dedicated to understanding how the patient is doing with his or her treatment regimen and knowing when and why a patient experiences an interruption in therapy. Based on the reason for the missed dose, the specialty pharmacy care team will follow up as appropriate with the patient or the patient's physician.

The insurance specialists on the care team understand the insurance requirements related to specialty pharmacy and can help the patient in obtaining financial assistance if needed. This allows the patient to focus on feeling better and provides the patient or caregiver some relief relative to the filing of complex insurance forms.

Specialty pharmacy is the fastest-growing segment of pharmacy today, representing more than $70 billion in sales. Right now, more than 1000 new medications are in the pipeline, contributing to a significant year-to-year growth trend for the specialty pharmacy market. During the next 15 to 20 years, this growth will represent close to a half trillion dollars, or more than 40% of the total drug-spend in the United States.

Specialty pharmacy is all about the patients, their families, and coordination among health caregivers. The specialty pharmacy team must work together with a patient-centric focus. The better patients understand their medications and possible side effects, the better their adherence. Specialty pharmaceuticals need to be part of the solution to assist patients in realizing the full benefits of these revolutionary treatments.