Pharmacists Weigh In on Specialty Medication Barriers and Shifting Industry Dynamics

In this conversation, Erica Marini, PharmD, MS, BCPS, neurology clinical pharmacist at Utah University of Health, and Mark Schneider, PharmD, clinical pharmacist at Vanderbilt Specialty Pharmacy, Vanderbilt Univeristy Medical Center, discuss the challenges that patients face when starting specialty medications and what recent changes may mean for access and affordability. They describe how complex therapies, lab and vaccine requirements, and home-delivery models can overwhelm patients when initiating treatment, and they emphasize the role of pharmacists in setting realistic expectations about adverse effects and treatment goals.

The pair also share early perspectives on CVS's move to separate its pharmacy benefit manager and insurance operations from its retail business, which may loosen patients’ ties to particular specialty pharmacies. They hope the change will lower costs and expand patient choice, with Schneider noting it is too early to definitively predict outcomes.

Pharmacy Times: What are the biggest access and adherence barriers you see for patients on specialty therapies?

Erica Marini, PharmD, MS, BCPS: I think the biggest barrier, in general, is that there are a lot of added complications, both with the medication being more complex and with the health care delivery system of specialty pharmacy being a lot more complex. Patients are used to getting a prescription and picking it up at their pharmacy. Instead, we're adding in all of these steps: get these labs, get these vaccines, follow this complicated schedule. It generally has to be delivered to your house; you can't go pick it up. Adding in all of those complications can be really overwhelming, especially at the start, and I see that as a big barrier, at least to initiating therapy in a patient on a specialty medication.

Pharmacy Times: What is your reaction to CVS separating its retail and specialty pharmacy businesses, and what does it mean for patients?

Marini: I hope this means good things. There has been a lot of need for PBM reform, so I didn't hate the news that the PBM and insurance side are splitting off from most of the patient-facing retail pharmacy side of the operation. I hope this means lower costs. I hope this means less of a conflict of interest, and that CVS can focus on patient care through the patient-facing parts of its organization.

Pharmacy Times: What do specialty pharmacists most need to get right when managing high-cost therapies for rare diseases?

Mark Schneider, PharmD: That's a good question. I think the most important thing is making sure it's affordable for patients. These are high-cost drugs, like you said. Getting it approved is the first half of the battle; making sure it's affordable is the other. And then, of course, there is setting expectations for patients who are on these therapies as well: understanding adverse effects and how to mitigate them.

Pharmacy Times: How can specialty pharmacists help patients with fibrosing interstitial lung disease start and stay on antifibrotic therapy?

Schneider: That leads into the previous question. It's really about setting expectations and letting patients know that they typically are not going to feel better on these medications. A lot of times, they may feel worse because of some of the adverse effects. So we let them know that when they come back for their follow-up appointments, pulmonary function tests, and screening, we want those numbers to stay the same.

Pharmacy Times: What's your reaction to the CVS split news from yesterday, and what does it signal about where specialty pharmacy is headed?

Schneider: That's some pretty big news. It's a little early to have too strong an opinion on it. However, I think it will have some effect on patients being locked into particular specialty pharmacies, so it will allow for choice, and typically, with choice comes a decrease in price for patients. So overall, hopefully a good thing.