The delivery and financing of U.S. healthcare is changing rapidly. Pharmacists and other healthcare professionals have to reinvent themselves as healthcare becomes more of a retail business. With the threat of new competition, the pressure for pharmacists to add value in healthcare is mounting.
Ensuring the appropriate use and management of specialty pharmaceuticals is one area in which pharmacists can offer unique and necessary expertise. These medications will have a profound impact on the practice of pharmacy over the next ten years as they consume more of the healthcare dollar. They will affect all pharmacy practice settings—e.g., community, hospital, long-term care, etc.—accelerating the importance of medication management to ensure the appropriate use of these therapeutic agents.
Retail, mail-order, and specialty pharmacies account for the distribution of about 45% of specialty drugs that are covered under the pharmacy benefit. The majority of specialty pharmaceuticals are distributed and administered in the physician’s office, an outpatient setting, or as home infusion. All are covered under the medical benefit.
The role of the pharmacist in the physician’s office will emerge as a way to manage patients taking certain specialty medications. Currently, patients taking specialty pharmaceuticals represent only 1% of the patient population, yet, amazingly, they represent 30% of total drug spend.
As specialty pharmaceuticals costs escalate—some in excess of $50,000 annually (e.g., Solvaldi, Olysio)—it makes sense to place pharmacists closer to the patient. Even home visits will have direct pharmacist involvement for patients when using these medicines.
Some community pharmacists can fill this role where appropriate, if they can help patients improve drug use, minimize waste and increase patient safety.
Systems will be developed to track patients across the healthcare system to ensure appropriate specialty medication use.
The most recent impact to the delivery of specialty drugs is “personalized medicine.” This term relates to the use of genetic testing—genomics—to guide the dispensing of the optimal type and dosage of a drug for a specified healthcare condition, through the identification of a patient’s individual cellular and genetic makeup.
For example, genetic testing can provide information about patients’ liver enzymes and predict the rate they metabolize specific drugs. This information provides guidance to the prescribing physician in the medical management of a patient. This is an opportunity for the community pharmacist to work in collaboration with physicians
Clearly, healthcare will need a different approach to the optimal dispensing of specialty pharmaceuticals. We have known this for years. The industry will need creativity and focus to demonstrate just how far specialty pharmaceuticals can take us.
The role of the pharmacist will be critical as specialty pharmaceuticals consume more of the healthcare dollar.