Do Clichés Apply To Specialty Pharmacy?


The focus on specialty drug development and approvals have raised questions as to whether traditional pharmacy was being replaced by specialty pharmacy.

Clichés or words of wisdom, you decide…. the golden rule in life is to treat others as you want to be treated. The golden rule in the world of pharmacy is never burn a bridge, as pharmacy is a small world.

The sayings, “what goes around, comes around,” and “what was once old, is now new again,” applies to both life and pharmacy, including specialty pharmacy. Applying these sayings to specialty pharmacy encourages a look back to the past, as much as it helps to forecast the future.

The focus on specialty drug development and approvals in recent time, may have left many wondering if traditional pharmacy was being replaced by specialty pharmacy. No need for concern about a specialty monopoly, as there are examples of specialty pharmacy options being delivered through traditional retail pharmacies, niche pharmacies, and in clinic settings.

Many pharmacists with a background in retail pharmacy migrated towards specialty pharmacy for the opportunities and growth available. The experience and knowledge that a pharmacist earns throughout a career is valuable and portable.

A background in retail pharmacy is well suited to support a specialty patient’s medication counseling needs, as a retail background develops a pharmacist’s communication and patient relationship skills.

A pharmacist with experience in both retail and specialty pharmacy could find themselves in demand to work in a start-up niche pharmacy or a hybrid pharmacy that offers specialty products. Always follow the advice to never leave a previous employer on bad terms, as that employer may be your future employer too.

Certain definitions once used to define and isolate specialty drugs could impact the future of specialty pharmacy. There are multiple ways to define specialty pharmacy, with one of the most common to segregate based upon price. If a drug cost was close to $1000 for a month’s supply that was reason enough to classify the drug as a specialty product.

The future changes to health care reimbursement will be based upon outcomes that could eliminate the idea that drug costs are a classification reason. Depending upon how the reimbursement model evolves, the idea of classifying a drug based upon cost will not be relevant, as the price will be rolled in to the overall treatment cost and not a standalone item. The most cost-effective drug that delivers the optimum results will be the clear winner in the future.

Specialty drugs are also categorized based upon general or restricted availability in the market and if the product requires special handling or data reporting to satisfy a REMS requirement. Many specialty drugs currently available are injectable products that are self-administered, requiring additional monitoring and support from a specialty pharmacist for the unique challenges the treatments present.

Years ago, injections and infusions only happened in a clinical setting, and one of the only self-injected medications was insulin. It is now commonplace for patients to be self-administering even complicated regiments.

The way to impact patients in a positive manner would be a focus on innovating small molecule drugs to treat what only has a complicated injectable or infused treatment today. If science and pharma can return to developing innovative small molecule drugs based upon scientific advances and what has been learned from the development of biologicals…what was once old is new again.

The advantage of small molecules for many patients is the ease to administer. For pharmacists, having both an orally administered or injectable product provides options that can drive adherence and simplify dosing routines. Having a non-injectable option is desired by many patients and caregivers, especially those with needle phobia. Could the future deliver both options for specialty? Time will tell.

Specialty pharmacies have been through the typical business cycle of mergers and acquisitions, which have resulted in some supersized specialty pharmacies. As the business cycle continues to evolve, there is an upswing in the number of small, independent, boutique specialty pharmacies.

The draw to a boutique specialty pharmacy is from manufacturers who specialize in developing drugs for orphan diseases. Bringing a drug to market to treat a limited number of patients does not necessitate the drug being on the shelf in 65,000 retail pharmacy stores. Nor does it require providing education about the orphan disease and the new drug to all retail pharmacies, which would be nearly impossible and unwarrented.

The pipeline of new drugs is slanted towards specialty products, and some of those products will be for orphan diseases, which indicates that boutique specialty pharmacies should do well into the future.

There will be plenty of new specialty drugs approved that may not need the high touch and intense monitoring available from a niche specialty pharmacy, so the traditional larger specialty pharmacies will be able to stay in the game too.

What will the future of specialty pharmacy look like? Retail and specialty pharmacists should focus on being involved in their patients’ care and well-being, as those are true indicators of successful health care treatments and interactions.

It is a small world and everything that goes around comes around….and specialty pharmacy should expect ideas from the past to repeat in the future. A good idea never gets old.

About the Author

Jill Schachte earned her BS in Pharmacy from Duquesne University and her Masters of Science in Pharmacy Business Administration (MSPBA) from the University of Pittsburgh. Jill has spent the past 20 years working in specialty pharmacy, starting as a clinical pharmacist at Stadtlanders Pharmacy and working in a variety of management roles in specialty pharmacy operations for CVS Health. Jill’s current role is on the CVS Specialty Professional Practice team, with a focus on accreditation and compliance for all the specialty pharmacy locations within CVS Health.

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