Breaking into the complex world of specialty medicines means navigating big challenges: dealing in staggeringly expensive inventory; developing or importing expertise in managing serious diseases and new drug therapies; counseling and monitoring patients and making sure they adhere to treatment regimens; evaluating and mitigating the risks inherent in those new treatments; and documenting patient interventions and outcomes. Still, there’s a clear role in specialty Rx for independent and small-chain pharmacy owners, industry leaders assert.
“In the independent community setting, some [operators] are gaining access to limited-distribution products … [and] winning payer contracts,” observed Chris Benz, director of marketing for Armada Health Care. “There is definitely an opportunity in the retail setting.”
Succeeding in specialty, Benz told Specialty Pharmacy, is largely a question of building relationships — with prescribing physicians and local health systems, payers, PBMs and, not least, manufacturers of high-maintenance specialty and biotech medicines in restricted, limited-distribution pharmacy networks.
Those aren’t insurmountable barriers, Benz asserted. “Certainly it depends on the disease category. But there’s still a large number of products that are open-access [and] available in the retail setting,” he noted. “And many specialty patients are ambulatory.”
“Some things, because of FDA [restrictions] or [risk evaluation and mitigation] requirements, may always be limited in distribution. But … more patients are looking to get product at their local pharmacy,” Benz added.
What’s more, independent pharmacists are ideally suited to specialty, asserted Tim Davis, a pharmacy owner who oversees a multistore McKesson Health Mart franchise in western Pennsylvania.
“With high-cost therapies that require a complex regimen, we have a chance to impact those patients and create positive outcomes, whether it be pharmaco-economically or clinically related to their care,” said Davis, who is active with the University of Pittsburgh’s School of Pharmacy and the National Community Pharmacists Association.
There is a void to be filled, he said. “The players that have historically been in this space have commoditized specialty pharmaceutical care,” Davis noted. “So independent pharmacists and smaller players have an opportunity … to bring specialty back to its roots of high patient care, thoughtful clinical regimens and management of successful outcomes.”
That conclusion spurred Davis and three partners to launch their own specialty pharmacy roughly two years ago with backing from venture capital firm Relentless Capital. Called PantherRx, it provides full-fledged specialty care aligned with the personal patient care of a community pharmacy.
“Retail can’t do everything in specialty,” Davis explained. The addition of a specialty component allows the company to offer both the accessibility and personal care that independent pharmacies excel in, he said, and the “therapeutic regimens and care coordination associated with [serious] disease states, as well as the management, handling and administration of those drugs.”
“We realized we needed to build a national network,” Davis told Specialty Pharmacy. “Our proposal to health systems is to utilize the distribution capabilities of Panther, while including the local pharmacies as sites of first fill, reimbursed education services and administration. Our vision is to be a hybrid — to utilize local relationships and care experiences, while managing it on a national basis.”
"A paradigm shift for us"
Moving into specialty involved “a paradigm shift for us,” Davis said, in technology, cash flow, limited-distribution pharmaceuticals, and the way the company builds and maintains relationships with payers, local health systems, physicians and suppliers. For instance, he said, pharmacies need technology that goes beyond managing workflow and helps in “effectively managing patients’ care protocols or therapy regimens.”
Not to be overlooked is the considerable investment in inventory. “We’re not dealing in $4 prescriptions anymore; we’re dealing with $4,000 prescriptions,” Davis pointed out. Participating in the federal 340B pricing program, which provides discounts on medicines for lower-income patients, helps partially allay the cost concerns, Davis noted.
Another hurdle was “understanding the contracts surrounding restricted networks and specialty pharmaceuticals,” according to the pharmacy owner.
“Even if we do have specialty prescriptions coming through the door, we’re not able to service some of them because of the restricted nature of the contracts,” Davis noted. “So we … transfer them to pharmacies that can service them, because we don’t want to lose the interaction with that [physician’s] office or that patient.”
To compete in specialty, Davis added, community pharmacies also must develop “the ability to aggregate and report on clinical and business metrics.”
“Many of these meds have requirements from payers or manufacturers to prove they’re doing what they’re supposed to, or being utilized correctly,” he explained.
Finally, Panther had to incorporate a marketing component “to generate the script referrals, to let prescribers and payers know our services exist, and what value we brought as a community pharmacy versus a mail-order specialty pharmacy,” Davis said.