Your biopharmaceutical manufacturing company’s new specialty drug has the potential to change patients’ lives. It may improve their quality of life or even cure them of a serious disease. But if patients can’t access your groundbreaking drug and stay on it, that potential is lost.
That’s where specialty pharmacies come in. By partnering with a specialty pharmacy, you can improve access and adherence to your drug—and help more patients find hope.
I’ll explain what a specialty pharmacy can do for your biopharma company, how those services can improve outcomes through greater adherence, and which capabilities you should look for in a specialty pharmacy partner.
Why specialty drugs are different
Your specialty drug offers a lot of potential. But it also brings with it a number of challenges that can get in the way of patients accessing and remaining on your drug. This includes:
- Cost. Your drug may be expensive. That creates a potential access barrier for patients.
- Uniqueness. Your drug may be the first of its kind, or the first in a therapeutic area. That creates a potential coverage issue for patients.
- Awareness. Your drug will require that relevant prescribers be educated on why your therapy may be right for their patients given the influx of new specialty therapies.
- Administration. Your drug may be a self-administered oral or injectable drug that patients only used to be able to take at a doctor’s office or in a hospital. Now they can take it at home.
- Clinical profile. Your drug may come with a complex treatment regimen or toxicity that requires regular patient monitoring.
A specialty pharmacy partner can help break down barriers like these.
How specialty pharmacies can help your patients
The services that a specialty pharmacy can offer fall into two phases. The first is pre-dispense. These are services that a provider performs before a patient starts on your drug therapy. The second is post-dispense. These services happen after a patient starts on your drug therapy. Each phase is critical to adherence and, ultimately, to outcomes.
Let’s talk about pre-dispense first. Most of the services a specialty pharmacy can provide during this phase are patient access functions. These help patients get access to your drug. There are four main tasks:
- Benefits investigation. The pharmacy verifies that a patient has drug benefits and that the benefits cover the prescribed drug.
- Prior authorization. The pharmacy gets approval from the patient’s health plan that it will cover the drug based on the patient’s medical condition and cost of the drug.
- Claims submission. The pharmacy submits a claim for the drug to the health plan. The health plan then decides how much it will pay the pharmacy and how much the patient has to pay out of pocket through co-insurance or a co-payment.
- Patient assistance. If the patient can’t afford the co-pay, the pharmacy works with you to offer financial aid like co-pay cards, subsidies from foundations or manufacturer free-drug programs.
The specialty pharmacy should perform all four tasks before it fills the prescription. And it can do all four in a matter of minutes if it has the right technology.
The post-dispense phase is next. Most of the services in this phase are clinical management tasks, which happen once patients get their prescriptions. These are the core specialty pharmacy services that start patients on their medications and help with adherence. In other words, these services help patients continue to take their medications properly. The tasks in this phase are:
- Patient education: Teaching patients how to take their drugs properly.
- Adherence monitoring: Making sure patients fill their prescriptions and take their drugs as prescribed.
- Patient monitoring: Working with patients to identify and then deal with any of their clinical, financial or emotional issues.
- Provider communication: Communicating with the patients’ providers to tell them how their patients are responding to the medication.
These are all high-touch services that focus on the clinical and emotional needs of your patients. They can make sure those patients are getting the best possible outcomes from your drug therapy.
How specialty pharmacy services can improve adherence
Specialty pharmacies can help boost outcomes by improving medication adherence. Each service they offer can drive adherence to your drug.
Let’s look at access services. Time is critical when it comes to specialty drug adherence. Patients who need your drug therapy are seriously ill. They can’t wait for the usual paperwork to go through. The time to first fill should be as short as possible. Patients who get on your drug quickly will see benefits more quickly, and they are more likely to stay on it for as long as necessary.
Patient monitoring is another example. Let’s say a patient experiences a manageable yet unpleasant side effect to your drug—but doesn’t tell their provider about it. The patient stops taking your drug because of a side effect you could have eased with an over-the-counter medication. With a specialty pharmacy serving as the prescriber’s eyes and ears, the patient reports the side effect, gets the OTC medication and stays on your drug therapy.
Patient access and clinical management drive adherence, and adherence drives better outcomes for the patients who need your drug.
Picking the specialty pharmacy that’s right for you
There are hundreds of specialty pharmacies out there. Each can fill a prescription, label it, verify it and ship it to a patient overnight. They can also provide most of the patient access and clinical management services I’ve described above.
So how do you select the specialty pharmacy that’s right for your biopharma company’s new drug? I would look for the following capabilities to find a match:
- Customization. Can the pharmacy customize access and clinical management services to your drug and the patients who need it? For example, each drug has a different profile, and yours may need a custom, rather than standard, cadence of checking on patients. It may also require flexibility in patient communication, such as phone calls, text messages, or web-based apps, based on patient preference.
- Launch experience. Does the pharmacy have launch experience? Has it worked with a drug manufacturer before launch to address a drug’s potential access issues, patient population, clinical complexity and logistical complexity? This will also help with commercialization.
- Data collection. Does your pharmacy have the ability to collect and report the data you need to track your drug’s performance? Time to first fill is one KPI. Other KPIs are time on therapy, financial aid secured, therapy discontinuations, and turnaround time for access services.
- Ancillary services. Can the pharmacy provide ancillary services that your patients need? Your patients may need medical supplies at home or require home health visits to get the most therapeutic value from your drug.
In today’s value-based care environment, where a drug’s efficacy is top of mind for every stakeholder, your biopharma company must demonstrate the value that your new drug creates for the healthcare system. That starts with each patient whose life you’ve changed with the help of a specialty pharmacy.
Related: Learn more about Studiomaca’s specialty pharmacy services for drug manufacturers