Putting "High-Tech, High-Touch" Back into Specialty Pharmacy

The roots of specialty pharmacy began in community retail pharmacy. Given a choice, specialty patients will choose a local specialty pharmacy to access their medicines and manage their care.

Over the last 20 years, specialty pharmacy has evolved into an unfamiliar mix of restricted access and processing centers that push out 10,000 prescriptions per day. It’s a novel idea to actually see a specialty patient. Let’s go back to the roots of every major specialty entity to find the origins of “specialty pharmacy.”

• The first limited distribution products included Betaseron through a lottery system with McKesson, and Crixivan, which was exclusive to Stadtlanders Pharmacy in Pittsburgh for the first 6 months of its existence on the market. These products entered the market in the mid-1980s. Eventually, both products evolved into open-distribution availability.

• Accredo evolved through the acquisition of various local and regional pharmacies such as Gentiva Health Services, which focused on hemophilia and other orphan disease states such as Fabre’s disease and Pompe’s disease. This is now a better than $10B entity.

• Caremark evolved through the acquisition of pharmacies such as Stadtlanders Pharmacy, which focused on HIV and hepatitis C. CVS also acquired the satellite ProCare stores, which had local presence and focused on oncology, rheumatoid arthritis, etc. This is now a better than $10B entity.

• Curascript was formed through a merger with Priority Health Care, which focused on direct distribution to the physician, primarily in the oncology space. This is now a better than $7B entity with the acquisition of Precision Therapeutics.

The moral of the story is that all the innovation in the specialty arena began in the community—and it is there that we believe it will continue to evolve.

Empirically, patients, providers, and pharmacists understand if you see the patient 12 to 14 times a year and you have a strong working relationship with the specialist, you are more likely to be successful in managing drug therapies effectively.

The bottom line is that the roots of specialty pharmacy began in the community retail pharmacy, where caring pharmacists took care of those in most need closest to home. Understanding that, in today’s marketplace, to be relevant with payers and prescribers, community pharmacies must form a collaborative network.

Community Specialty Pharmacy Network (CSPN) was created to provide the stakeholders in the specialty market with an access point to the patients, prescribers, and health system administration that is “face-to-face.” Disease state centers of excellence were created to provide highly personalized drug therapy management and succeed where the current central-fill mail order model fails. One area that is a glaring problem and an example of a care management environment that relies on call centers to onboard patients into complex drug therapies is that 25% of all specialty prescriptions go unfilled. The vast majority of these failures to initiate therapy are economic, which is shameful in light of the fact that virtually every specialty manufacturer provides a suite of patient assistance programs to lower drug and copay costs.

In the community specialty pharmacy network, member pharmacies provide a face-to-face initial on-boarding consultation that includes patient enrollment into these programs. Clinical pharmacists perform comprehensive drug reviews in private consultation rooms. Network pharmacies can dispense all of their patients’ medications, not just a narrow formulary of specialty drugs; fulfillment may also include limited distributed drugs via in a network “limited distributed drug HUB.” Additionally, these sessions include a review of possible drug interactions, side effects, and therapy regimen planning. Once on therapy, patients experience a highly personalized service model, which allows for the “high-touch” component to drive compliance to the highest levels in each disease state we service.

To be successful, a network of community pharmacies must provide patients with the highest level of service and aggressively manage the cost of drug therapy across all specialty disease states. An effective network creates centers of excellence that establish a set of trusted resources in the communities they service and play a vital role in managing these complex and difficult disease states and associated drug therapies. With a commitment to care, community specialty pharmacists believe that given a choice, specialty patients will choose a local specialty pharmacy to access their medicines and manage their care—making their centers of clinical excellence a trusted and relied-upon necessity in the community.

CSPN’s network includes 200+ pharmacies that operate in 47 states, the District of Columbia, and Puerto Rico, where it currently services 100,000 specialty lives with a focus on oncology, hepatitis C, multiple sclerosis, rheumatoid arthritis, and Crohn’s disease, making it one of the top 10 of specialty providers and growing. Non-core specialty areas are transplant and infertility.

SPT

About the Author

Crocker is chief executive officer of Community Specialty Pharmacy Network (CSPN). CSPN’s member pharmacies are known for being “centers of excellence” in disease management and its network of pharmacies is the nation’s 10th largest specialty pharmacy provider. CSPN serves as the central contracting agent for its members in the specialty provider network arena, pharmaceutical manufacturer rebate initiatives, and in patient adherence and compliance programs. Previous to joining CSPN, Gerry was chief executive officer and president of the Board of Directors for CARE Pharmacies, Inc. Gerry was vice president of retail and alternate care sales for Cardinal Health East Group prior to his role at CARE Pharmacies. Gerry holds a business administration degree from Northern Michigan University in Marquette, Michigan.