According to a recent by Drug Channels, specialty drugs will represent 42 percent of pharmacies’ $572 billion in total prescription revenue by 2021, up from 28 percent of $412 billion in total prescription revenue in 2016.
It’s no wonder then that retail pharmacies want to be part of this trend. Many correctly believe that dispensing specialty drugs is essential to their clinical and financial success in the future.
But not every retail pharmacy that wants to be a specialty drug dispenser will become a specialty drug dispenser. That’s because specialty drug manufacturers are very particular about who they partner with to dispense their sophisticated, high-cost medications to treat complex and chronic medical conditions.
In working with specialty drug manufacturers, I’ve determined what core competencies they’re looking for in a pharmacy dispensing partner. The overarching goal is always exceptional patient care and outcomes, but in the world of specialty drugs, it takes a distinct set of capabilities to successfully meet that goal. Retail pharmacies that hope to partner with specialty drug makers should have the following five capabilities in place.
1. Payer and Pharmacy Benefit Manager Relationships
The first thing a manufacturer is looking for in a specialty drug dispensing partner is the pharmacy’s contractual relationships with health plans and PBMs. Manufacturers do not want a patient in need to be turned away or face additional challenges due to lack of coverage. To ensure a manufacturer is confident in the pharmacy’s ability to cover a broad set of lives, the pharmacy should have relationships with multiple plans and PBMs serving its intended market. A pharmacy with limited or narrow payer and PBM relationships would be challenged to show its ability to dispense to a wide set of potential patients.
2. Patient Payment Assistance and Claims Adjudication
Specialty drugs are not cheap. According to the Centers for Medicare & Medicaid Services, specialty medications cost $600 or more for a 30-day supply. Many cost more than $10,000 per month. From a manufacturer’s perspective, it needs to be confident that a pharmacy dispensing partner is able to make its specialty drug as affordable as possible for patients when they come through the pharmacy door. Affordability can’t be a barrier to adherence. That starts with insurance coverage, but it’s far more. The question for a manufacturer is whether the pharmacy is using all available programs to help patients afford their medications. The other skill sets include the ability to handle co-pay cards, navigate complex claims adjudication systems, manage prior authorization procedures and effectively verify step-edit programs. In sum, the pharmacy must be appropriately skilled to reduce the out-of-pocket burden on patients to the fullest extent possible.
3. Patient Clinical Support and Education Services
Given the high clinical and financial stakes intrinsic to specialty drugs, a manufacturer wants a pharmacy partner that provides disease-specific clinical support to patients to complement the financial support. Clinical support should include: patient education to ensure a drug is taken as prescribed; preventative services to mitigate any side effects from using a particular specialty drug; follow-up care to determine whether a specialty drug is having the desired clinical effect; adherence tracking to know whether refills are being made; and consults with the physician prescriber to adjust medications if necessary. Top-tier specialty pharmacies dedicate a lot of resources to support the patient clinically. Retail pharmacies that want to partner with specialty drug manufacturers must demonstrate the same commitment and clinical expertise.
4. Data Collection and Reporting
A manufacturer wants a specialty drug pharmacy partner that has the technology infrastructure to drive optimal patient care and outcomes. Systems need to not only handle the claims adjudication functions and financial support, but also need to facilitate patient assistance programs and drive improved outcomes. The manufacturer must be confident in the pharmacy’s technical capabilities and will seek ongoing data feeds to validate efforts and outcomes. Examples of sought after capabilities are integration into EHR and payment systems, longitudinal patient tracking, support program utilization and outreach tracking and adherence monitoring. A successful retail pharmacy will have technology capabilities that both drive value and can be reported back to manufacturers.
5. Specialty Drug Handling, Storage and Shipping
The last but no less important competency a specialty drug pharmacy must have from a manufacturer’s perspective is the ability to physically manage the drugs themselves. At $10,000 or more for a 30-day supply of pills, a manufacturer needs to know that its pharmacy partner takes inventory management seriously. That includes having the right amount of a specialty drug in stock to serve its patients but avoiding excess inventory sitting on a shelf. Of course, the pharmacy must demonstrate to the manufacturer that it knows how to appropriately handle, store and dispense a specific specialty medication as required. For example, many of these drugs are now oral or self-injected medications and are shipped directly to patients. The pharmacy must be adept at packing and shipping these drugs and able to track orders.
Just because a pharmacy possesses all five capabilities I’ve described, it does not guarantee success in the specialty product space. Each manufacturer will look for capabilities needed for the specific product, therapeutic area and patient needs. They will consider which retail partners have the capabilities to accomplish the most important goal: exceptional patient care and optimal outcomes. Given that the future of the prescription drug market is being reshaped by specialty drugs, these capabilities are important considerations for any retail pharmacy to contemplate while determining a specialty drug strategy.
Related: Learn more about Studiomaca’s specialty pharmaceutical solutions for retail pharmacies.