Understanding and Exploring the Practice of Specialty Pharmacy - Episode 4

Episode 4 - Navigating Barriers to Therapy and Reimbursement

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Ray Tancredi, RPh, MBA, CSP, vice president of specialty pharmacy development at Walgreens; Cheryl Allen, BS Pharm, MBA, vice president of business development and industry relations for Diplomat Pharmacy; Nicholas Karalis, RPh, of Elwyn Pharmacy Group; Stacey Ness, PharmD, RPh, CSP, MSCS, AAHIVP, director of specialty clinical services for Managed Healthcare Associates; and Renee Rayburg, RPh, senior director of clinical consulting at Artemetrx, examine the issues surrounding the barriers to starting a specialty therapy regimen that patients may face.

Among the key barriers for patients to begin a using a specialty drug are prior authorization, affordability, and coverage, as Ness noted that starting a specialty therapy represents a complex new world for patients to navigate in gaining access to these medications. Karalis said that the process has improved as additional funding entities help to speed up the pace at which patients are able to access a particular therapy.

With electronic prior authorization becoming more prevalent, companies utilizing that service may include a type of co-pay assistance mechanism with every new specialty drug that hits the market, Karalis added. Allen noted that companies with supportive portals that can enroll patients in co-pay assistance programs reduce time delays, which prevents a drop off in therapy.