What Matters Most in Specialty Pharmacy?


The specialty pharmacist has to balance myriad competing priorities in managing a specialty therapy regimen.

What matters most? Great question, right? Why ask it about specialty pharmacy?

The question, what matters most, inspires deep reflection on a situation, and contemplation about prioritizing your values. When the question is answered sincerely, it is difficult to argue against the response.

If the question is answered without heart or conviction behind the words, it feels like a “sales pitch,” and you walk away, soon forgetting what was just said. If all you hear are empty words, and broken promises are delivered, you do not matter to the person answering the question.

We all want meaningful work, meaningful service, and meaningful relationships in every aspect of our days. We want to be listened to and heard. We all want to matter.

Why ask this question? I ask it all the time, it helps to pick the battle worth fighting and never stopping that fight. It helps re-center my thoughts and focus on what needs to be accomplished to move forward.

When I am honest with myself, I can put my full effort into whatever I am doing, and do it without regret. In a world that admires multi-tasking, and the days are filled with information from technology at our fingertips, the question of what matters most is a reminder to stop giving attention to distractions.

Specialty pharmacy has many distractions, and can easily become overwhelming by just meeting the REMS requirements, data collection, reporting, clinical support, and interactions. All of this before ever speaking to a patient.

Who matters most to a specialty pharmacy? The best answer is it depends….

In specialty pharmacy, there are many touch points and players interacting on a variety of levels. The specialty pharmacy’s relationships with manufacturers, providers, and patients, are essential to a healthy business model.

Those 3, the manufacturer, provider, and patient, are intertwined in a way that can be symbiotic; yet still needs the specialty pharmacy to act as a conduit for the flow of information between them. The pharmacy must be easy to work with, supportive and responsive, otherwise there is risk to losing any one of these relationships.

Specialty pharmacy may be the fastest growing segment of health care, but it is extremely competitive, which means maintaining all existing relationships is essential to future success. Relationships matter.

The manufacturers tend to partner with established specialty pharmacies if the product has a REMS requirement. They know that the pharmacy has prior experience with REMS compliance and this could be an important piece of information in considering limited distribution arrangements.

Manufacturers of specialty products demand data capture on a variety of elements, most importantly inventory control. Inventory control is essential to the balance and costs associated with manufacturing, distribution, and patient sales. Therefore, working with an SP that demonstrates the ability to provide this information, and having a respected reputation in the SP industry with other manufacturers, providers, and patients are critical factors to take into consideration.

If an SP cannot gain access to a manufacturer’s products, due to limited distribution or other reasons, it is a significant disadvantage for the SP to fully service a disease state, if access to every product in a therapy line is off-limits. Not having current access to a manufacturer’s products also implies that having access to any new-to-market specialty products from this same manufacturer could be an uphill battle.

Once providers or patients learn where a product is available, this will play into the decision of which SP to consider when the time comes to begin therapy. The logical choice is to select an SP with access to all products in the therapy line.

Why would a patient want to start with one pharmacy only to need to switch and start the on-boarding process all over again in a few months when the prescriber determines a change in therapy is warranted? This example makes it clear why a solid relationship with a manufacturer matters.

Prescribers come in all shapes and sizes, meaning an SP will work with physicians. Some are specialists, others are general practitioners, some will have knowledge of specialty pharmacy, others will rely on you for step-by-step support through the maze.

Don’t overlook the physician’s assistants and CRNPs who are prescribing too. Some of them will be working in a specialist setting, and have a greater knowledge of how specialty works, while others will need the SP to help navigate the process.

Navigating the path through specialty pharmacy needs to occur efficiently, and almost without the prescriber’s awareness. An SP will gain a reputation for being easy to work with when it masters the ability to support the needs of the prescriber without the prescriber needing to ask questions, or having to contact the SP for follow-up on a patient’s prescription.

An SP that communicates proactively and timely with a prescriber has created an essential foundation for the relationship. The prescriber notices the difference between SPs and when the prescriber can choose an SP, the one with the strongest relationship will get their business.

The prescribers know what they want in a partner, and they chose the SP that offers support and focuses on what matters. The prescriber-patient relationship should be viewed as sacred.

If an SP gives an indication to a patient that their prescriber is not responsive about a prior authorization or something of that nature, that plants a seed of doubt with the patient. Patients might wonder if the prescriber cares, and even report that perception back to the prescriber, asking, “Do I matter to you?”

The SP’s role is to protect the prescriber-patient relationship. The patient is what starts and ends this entire cycle. The patient has a medical need. The visit to the prescriber results in a diagnosis of a rare disease.

Luckily, a manufacturer has a prescription product on the market (available only through a limited distribution model at a few SPs) that is indicated for treatment of this rare disease. The prescriber submits a prescription for the product to the SP most familiar to the practice who has access to this product.

The pharmacy portion of this process begins with a phone call to the patient, explaining the role of the specialty pharmacy in therapy, how the process works, the support options available for clinical questions to even lifestyle and dietician needs when appropriate. The SP is truly successful when the patient understands there is support through the prescription process, even if there are additional levels of complexity for reimbursement.

The SP will minimize difficulties, and make the process a streamlined as possible, by keeping the communication between all parties current. The patient should never ask, “Do I matter?”

Who matters most in specialty pharmacy? For me, as a pharmacist, my answer is always the patient.

I chose a health care career to help and make a difference to someone. That someone is always the patient.

I said there is no right answer, but for me there is a best answer…the patient matters most.

About the Author

About the Author

Jill Schachte earned her B.S. in Pharmacy from Duquesne University and is currently enrolled in the Masters of Science in Pharmacy Business Administration (MSPBA) program at the University of Pittsburgh, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines. Jill has spent the past 20 years working in specialty pharmacy, starting as a clinical pharmacist with Stadtlanders Pharmacy and working in a variety of a 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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