Specialty pharmacies are a response to newer, high-cost pharmaceutical and biologic drugs that require special handling in terms of administration and reimbursement. The growing complexities of medical billing and coding have also contributed the rise of specialty pharmacies.
How important are they to the U.S. health care system? At least three-quarters of of health plans now outsource at least some of their delivery and financing of drugs to specialty pharmacies.
While chronic disease patients represent only about 3 to 5 percent of the population, they account for 55 to 65 percent of total pharmacy costs, according to CuraScript, a specialty pharmacy company in Orlando, Florida.
These statistics are expected to rise along with the aging population and increases in age-related diseases such as Alzheimer's disease, cancer and cardiovascular diseases. With more high-cost biologic drugs coming to market, and even more in the development stage, greater involvement of specialty pharmacies in health care delivery is a certainty.
Examples of Services Provided By Specialty Pharmacies:
- Delivering medications and supplies to patients' homes and training patients how to self-administer the drugs. For example, an employee of a specialty pharmacy would teach a patient how to administer multiple sclerosis, rheumatoid arthritis or Hepatitis C medication.
- Opening and managing continual case management between patients and health care providers, home care specialists and pharmacists.
- Advising health plan (insurance and Medicare) providers on how to manage and implement access to new pharmaceutical products as they enter the marketplace.
- For drug benefit managers, specialty pharmacies track and monitor the inventories of specialty drug manufacturers.
- Finding co-payment assistance or alternative coverage for the patient. Many newer biologic drugs may not be covered by private insurance. Some biologics, such as certain multiple sclerosis drugs, can cost $40,000 a year or more.
Specialty Pharmacy Companies:
Below is a partial list of the major specialty pharmacies in the United States. Currently, two firms are responsible for the majority of specialty pharmacy activity. The largest specialty pharmacies have entered into exclusive arrangements with retail pharmacy chains.
Express Scripts, headquartered in St. Louis, Missouri, provides specialty benefit management, claims processing, home delivery, drug data analysis, among other services. With its July 2012 agreement with the Walgreen's retail chain, Express Scripts expanded its retail pharmacy network to 64,000 pharmacies nationwide.
Headquartered in Woonsocket, Rhode Island, CVS Caremark provides mail order, retail and specialty pharmacy services for 60 million health plan members and operates more than 7,300 pharmacy stores and 600 Minute Clinics.
Smaller specialty pharmacy firms include Avella Specialty Pharmacy, Diplomat Pharmacy, ICORE and Omnicare, among others. In recent years, many specialty pharmacies like Medco and Accredo merged with or were acquired by Caremark and ExpressScipts.
Fein, Adam, PhD, “7 Reasons Why Specialty Drug Dispensing Will Boom,” Specialty Pharmacy Times, May 29, 2012
Suchanek, David, “The Rise and Role of Specialty Pharmacy,” (PDF) Biotechnology Healthcare, October 2005
McCain, Jack, “Connecting Patients With Specialty Products,” Biotechnology Healthcare, Summer 2012