For individuals outside of the pharmaceutical or healthcare industries who are not readily familiar with the difference between specialty pharmacy and conventional pharmacy, the distinction is certainly not academic. According to the National Association of Specialty Pharmacy, a specialty pharmacy is formally defined as “a state-licensed pharmacy that solely or largely provides only medications for people with serious health conditions requiring complex therapies. These include conditions such as cancer, hepatitis C, rheumatoid arthritis, HIV/AIDS, multiple sclerosis, cystic fibrosis, organ transplantation, human growth hormone deficiencies, and hemophilia and other bleeding disorders.”
Due to their highly complex nature, some specialty medications require special care, handling, and storage. Also, some medications are delivered orally, while others require injection or infusion (often in a hospital or doctor’s office). Consequently, pharmacists who work in specialty pharmacies must undergo rigorous training that covers all aspects of the care continuum, including how to use various medications, assess treatment plans, monitor patients, and liaise with members of each patient’s healthcare team such as their physician and caregivers.
“It was not that long ago that specialty pharmacies were a novel and obscure aspect of the pharmacy landscape,” commented pharmacist Andrew Hanna of Cornwall Ontario, who leads a growing specialty pharmacy in Cornwall, Ontario called Cotton Mill Pharmacy. “However, over the last couple of decades, specialty pharmacies have dramatically increased in popularity and influence. In fact according to data published by the IQVIA, U.S. specialty pharmacy industry revenues jumped from 34.9 percent of the overall pharmacy industry in 2014, to 45.4 percent in 2018. And with the growing incidence of patients suffering from complex conditions, it is expected that specialty pharmacies will continue growing and expanding well into the future.”
While it would be incorrect to perceive that specialty pharmacies are engaged in fierce competition with conventional pharmacies — after all, they are both committed to treating patients, and in this respect, they are categorically on the same team — it is also simply the case that specialty pharmacies offer an enhanced level of support and service that goes well beyond the typical retail level. These enhancements include: ensuring safe and controlled medication distribution, reducing costs to patients, educating patients, and assisting with medication management. Each of these is discussed below.
Ensuring Safe and Controlled Medication Distribution
In many communities, small patient populations cannot readily access the medication they need from a conventional retail pharmacy. Specialty pharmacies fill this critical supply chain gap by ensuring the safe and controlled distribution of complex, high-risk medications to these individuals.
“Many retail pharmacies simply do not dispense high-risk medication, and without access to a specialty pharmacies patients would endanger and jeopardize their health — which could lead to negative consequences,” commented Andrew Hanna. “At the same time, specialty pharmacies help drug manufacturers access information and insight over each patient’s experience, and ultimately use this intelligence to innovate and improve their product — which benefits many patients in the big picture and long run.”
Reducing Costs to Patients
Due to their high development costs and relatively limited distribution, specialty medications can be quite expensive — and for some patients with chronic conditions, this can become a difficult and potentially unsustainable financial burden. Specialty pharmacies play an important role in reducing costs to patients by thoroughly understanding manufacturing programs and clinical literature, and when applicable intervening when a clinically equivalent — but lower-cost — treatment is available.
“Without question or exception, the primary goal of specialty pharmacies is to maximize clinical outcomes for their patients,” commented Pharmacist Andrew Hanna, who is an active member of the Champlain Regional Pharmacist Committee. “However, there are also opportunities to appropriately reduce costs to patients that do not compromise this commitment to patient care and safety. As a pharmacist, one of my most important duties is to do what I can to help my patients lead healthier and happier lives. Telling them that they can get the same clinical outcomes but at a significantly reduced cost is a part of this mission, and I can assure you that it is the kind of news that my patients are very happy to learn.”
Both conventional retail pharmacies and specialty pharmacies strive to educate patients. However, specialty pharmacies take this effort to a significantly higher level, because they dispense medications that have substantially more complicated regimens. Furthermore, many patients who suffer from complex, chronic, or rare conditions have been prescribed multiple medications and can be confused and concerned regarding their proper dosage.
“A survey has found that 91 percent of chronic patients say they need help to manage their disease, and 61 percent of patients say that they are not even somewhat knowledgeable about how to effectively manage their chronic condition,” commented Andrew Hanna, who believes that the role of a pharmacist is a calling and not merely a vocation. “Specialty pharmacies have additional staff who are trained to lean forward and spend quality time with patients, answering questions, providing guidance, and serving as a trusted, friendly and familiar member of their primary care team. Indeed, over the years patients who have come into my specialty pharmacy have been shocked by how much time and care we provide. They are used to a more clerical retail pharmacy experience, where at most you might get a few minutes — or sometimes a few seconds — to speak to a pharmacist, before being handed a pamphlet or some literature that is riddled with medical and pharmaceutical jargon. Specialty pharmacies focus on guiding and advising patients, and personally, it is one of the most rewarding aspects of my role.”
Assisting with Medication Management
As noted above, specialty pharmacies play a pivotal role in educating patients. A key aspect of this — but one that is so vital that it deserves its section and spotlight — is assisting with medication management, and making patients aware of potential risks.
“According to the CDC, adverse drug events cause approximately 1.3 million emergency department visits each year,” commented Andrew Hanna, who in addition to his work as a pharmacist is also a medical cannabis consultant and provides topical Botox facial creams. “Specialty pharmacies scrutinize the other drugs that each patient is taking, and can proactively identify interaction risks that a patient might not readily be aware of. This not only promotes better clinical outcomes, but it can prevent adverse outcomes, and in extreme cases avoid a terrifying and painful trip to the hospital.”