Specialty Pharmacy Explained

Retail Pharmacy vs. Specialty Pharmacy

You might be familiar with retail pharmacies. These are establishments where you can purchase over-the-counter medications such as pain relief, allergy care, and cough suppressants. You can also pick up your usual prescriptions from retail pharmacies. The pharmacists here provide general healthcare advice to the public. Most retail pharmacies sell many other items and can be seen as stores of convenience for most of your needs.

Specialty pharmacies, on the other hand, deal with specific specialty medications that cannot be found in retail pharmacies. These pharmacies are targeted on high cost products that are used to treat complex specific disease states including chronic and rare conditions. Specialty pharmacies not only dispense oral, injectable, and biologic agents, but provide remote patient care. Employees at specialty pharmacies fulfill completely different duties using a unique skill-set to navigate the complexities between insurance, providers, and the patient. They are patient advocates, helping with co-pay assistance, medication management and therapy compliance, all to improve the patient's health. Communications with patients can occur a variety of ways including phone calls, mobile-enabled patient assessments, and/or patient pickup.

What are Specialty Medications?

Specialty medications are oral, injectable, inhaled or infused medications characterized as high cost drugs. These medications are large molecules and complex proteins that undergo a biotech process to create. Non-specialty drugs are simpler to create using a chemical process and typically pressed into a pill or filled in a capsule. Specialty medications are more complex to administer and handle, often necessitating special shipping and storage requirements such as temperature control. these medications require advanced patient support needs usually due to severe side effects that can impact adherence. They have complex payor coverage requirements under medical or pharmacy benefits. Specialty medications are used in treatment of many different therapeutic categories.

Some common specialty therapeutic categories that you've probably heard of are:

Blood disorders
Heptatitis B & C
HIV/AIDS
Infertility
Multiple Sclerosis
Oncology (Cancers)
Rheumatoid Arthritis

Traits of a Specialty Pharmacy

Provides high touch care to specialty patients including prescription fulfillment, preauthorization and financial assistance, medication and therapy education, counseling, adherence improvement strategies, refill reminders, and monitoring therapy outcomes
Responsible for purchasing and handling of specialty medications
Assists physicians and clinic staff with the medication acquisition process including benefits investigation, prior authorizations, and administration training
Provides quick turn-around time for fulfillment of new patient referrals
Coordinates with care providers such as nurses and clinics for injections and infusions
Provides quality controls for medication handling and shipment
Patient Care Coordinators have strong acumen in navigating insurance coverage criteria and patients' benefit design
Coordinate care with the patient's prescriber and other healthcare workers to ensure seamless care and monitoring
Clinicians have an in-depth knowledge of specialty diseases and medications