Understanding Specialty Pharmacy (Part 3): Intersections With Retail Pharmacy

Read Part 1 and Part 2 of the Understanding Specialty Pharmacy series.

If we consider the world of specialty pharmacy through the eyes of retail pharmacists, there are a few frustration points.

As we touched on when introducing specialty pharmacy, there is no universal list of specialty medications, which can cause a disconnect when coordinating care between prescribers, pharmacies, payers, and patients. A physician may prescribe some specialty medications unknowingly to the local pharmacy and later the patient may find that their insurance plan requires it to be filled through a specialty pharmacy, even though the retail pharmacy has a bottle in stock. This can happen often because 1 payer may identify different drugs as specialty than another. Explaining this rejection to a patient becomes challenging and can be frustrating for pharmacists who may feel it is more practical and beneficial to fill the prescription at the retail store. Additionally, the extent to which individual retail pharmacies may stock or be able to order specialty medications may also differ greatly from one to the next as well, depending on many factors. This can cause further confusion and frustration for prescribers and patients looking to find the medication locally. Similarly, a pharmacy may go from being able to fill a drug one day to requiring a transfer to a specialty pharmacy for the next fill because of availability, company policy change, or due to plan requirements. 

Even though there are these few points of frustration and potential knowledge gaps, retail pharmacists are typically much more familiar with specialty pharmacy than a consumer. As we know, specialty pharmacy is one of the newest and most successful branches of pharmacy and is rapidly growing, but many consumers still know so little, if anything about it. 

So, the question becomes: how can retail pharmacists support new-to-specialty patients and thus specialty pharmacies? 

Most of this support comes in the form of retail pharmacists doing something they are already inherently good at: providing patients with counseling and a listening ear as they begin this new, complicated journey. Retail pharmacists are some of the most accessible and trusted health care providers in the country and in some scenarios may be the first person to realize that a patient’s therapy will require specialty pharmacy. Pharmacists can help their patients who are new to specialty by simply explaining why a medication may require a specialty pharmacy and what the patient may expect, then recommending and transferring the prescription to a specialty pharmacy if possible. Also, in some cases, retail pharmacists can help by contacting the patient’s insurance provider to learn more about potential rejections, or simply by putting them in touch with someone else who may be able to help them more. 

A model becoming more popular in the industry that has helped retail pharmacists support patients as well as simplify the conversion process is specialty pharmacies affiliated with pharmacy benefits managers and/or retail pharmacy chains. These models can make it especially easy for a patient to get their specialty medication if they are already getting other medications from an affiliated retail pharmacy. This is because the company will usually have demographic and insurance information for the patient and can often automatically complete the prescription transfer. As you can see, there is much being done to integrate the worlds of retail and specialty pharmacy, but there is still work to be done to make this process even smoother for new patients. Though the specialty pharmacy model may be complex, one thing is quite clear: these pharmacies provide a vital service to patients and fill an otherwise unmet need in the industry. As we’ve discussed here, there are many things retail pharmacists can do to support their patients who, likely more than ever, will need this counseling and expertise. 

About the Author

Molly Gombos earned her Doctor of Pharmacy degree from the University of Pittsburgh in 2014 and is currently enrolled at Pitt in the Master of Pharmacy Business Administration (MPBA) program, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines. Molly has spent the last 7 years working in community pharmacy, initially as a pharmacist and pharmacy manager and most recently working in pharmacy operations. Her current role is working in the patient safety and clinical space with focus on clinical decision support.