The number of accredited specialty pharmacies continues to grow – from 378 to 1,207 since 2015 – and much of this growth is driven by health systems, which now make up about 39% of the total figure. But even though many health systems have some sort of specialty pharmacy, most still have quite a bit of untapped potential. When properly implemented, specialty pharmacy can touch and improve all other areas of your health system, including infusion care services, 340B program performance, system-wide financials, and more.
Here is a look at what a specialty pharmacy is and how adding this service to your health system can have long-lasting, far-reaching advantages.
What is a specialty pharmacy?
A specialty pharmacy provides very high-cost medications used to treat rare or complex health problems. In many cases, specialty products are used by fewer people, so local pharmacies likely don’t have them in stock or cannot supply them due to payer or manufacturer restrictions. This is where a specialty pharmacy comes in.
Specialty vs. Non-specialty products
Non-specialty products constitute the vast majority (>99%) of prescriptions filled by consumers nationally. From the retail or community pharmacy perspective, they are primarily volume-driven and usually result in very minimal or even lost profit margin. Because of this, many independent pharmacies have been struggling to turn a profit.
Specialty products, on the other hand, constitute less than 1% of total prescription volume but account for over 50% of the nation’s drug spend. Due to their high cost, pharmacy profit margins can be substantial once an organization establishes specialty pharmacy services, collaborates with clinics, and increases their patient recruitment and retention.
Key variables that might make a product a “specialty product” include:
- They are disease-state focused. For example, the core drug therapies for oncology, rheumatology, gastroenterology, and endocrinology are specialty products.
- They involve a drug approval process, wherein the FDA might say the product has dangerous side-effects that require additional screening.
- As part of the above process, the manufacturer has to certify pharmacies to provide the products. If a drug is approved with a risk evaluation and mitigation strategies (REMS) program, the manufacturer may have to certify specific pharmacies, which inherently creates a smaller network of pharmacies that would be included.
As a general rule of thumb, if a drug is particularly expensive, it is most likely a specialty product.
Why should health systems have specialty pharmacies?
Reasons to add a specialty pharmacy to your health system include:
- Improved financial performance and a new source of revenue for the organization
- Improved patient care with the ability to holistically manage complex patients within the health system between provider and pharmacy.
- Improved efficiency in the ability to serve patients within the health system to ensure their drugs get to them before they leave the hospital.
- Increased provider visibility into patient care by delivering specialty products within the health system to help providers know what is going on between visits (rather than waiting nine months between visits to get an update).
- Specialty pharmacy provides visibility into every aspect of care, as everything is documented internally, including information on side-effects and adherence problems.
- Improved clinic and provider efficiency by offloading complex prior authorization and insurance-related paperwork out of the clinics and to highly skilled and lower-cost pharmacy personnel.
Visante’s approach to specialty pharmacy
At Visante, our clients are our partners, and we believe holistically that the internal health system’s specialty pharmacy business model is best for patients and for health systems. Unlike our competition, we quickly develop clients to the point of self-sufficiency and high performance via our customized implementation service model.
We support health systems to implement and manage all aspects of their internal program in a manner which maximizes early and long-term financial returns. We recognize that no two programs are exactly alike, and we take pride in developing customized solutions for clients that are highly configured to their environment.
Our goal with our specialty pharmacy services is simple: to drive value for health systems in terms of their specialty pharmacy performance while improving patient care and solving a workforce need in the marketplace.
Contact us today to learn more.