While pharmacy costs still comprise only about 10-12% of total health care expending, that percentage continues to rise. The amount of money afforded to ‘drug spend’ has caught the attention of payers, politicians, and the general public. Inflationary pressures on existing drugs account for some of these increases, but much of it revolves around newer pharmaceutical agents and biologics referred to as “specialty” drugs. These drugs are usually large-molecule entities with special storage requirements, specific routes of administration (eg, intravenous infusion), are expensive to manufacture (with methods such as recombinant DNA technology), and are often used to treat serious conditions, such as auto-immune diseases.

Pharmacists are increasingly employed in managed care environments or may be in more frequent contact with various stakeholders in the supply chain of these products. Managing in a specialty environment requires careful and clear communication with other stakeholders, knowledge of marketing, pricing, contracting, and being especially adept at managing formularies and inventory costs, as well as effective oversight of programs aimed to assist patients who are on these medications.

A study by Zullig et al mined data from a cancer center’s specialty pharmacy. They found that even with insurance, some patients on chemotherapeutic agents were left with significant out-of-pocket (OOP) expenditures. The specialty pharmacy had achieved only modest success in placing patients on manufacturer-sponsored assistance programs (PAPs), with those programs overall accounting for approximately 15% of the prescription’s median cash price. The authors provide insight into how effective deployment of human (technicians, other personnel) and other resources could be of greater assistance to a larger number of patients.

Effective management in the specialty pharmacy environment can be of great help to patients and also assist the organization with budgetary considerations and facilitate greater patient satisfaction.

Additional information about Applications in Managed and Specialty Environments can be found in Pharmacy Management: Essentials for All Practice Settings, 4e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 4e. If your institution does not provide access, ask your medical librarian about subscribing.

¹Zullig LL, Wolf S, Vlastelica L, et al. The role of patient financial assistance programs in reducing costs for cancer patients. J Managed Care Pharm. 2017;23:407-411.