Balancing Patient Access and Cost Containment in Specialty Pharmacy

Specialty pharmacies have the experience and expertise to help patients and caregivers navigate the complex reimbursement processes surrounding specialty products. The goals are to simplify the process for patients, payers, and prescribers, and to ensure affordability is not a barrier to treatment.   

Contracting with manufacturers for discounted prices, and aiding physicians in the prior authorization process, are two examples of cost-management offerings provided by specialty pharmacies. These entities also work to cap the out-of-pocket expenditures of patients. 

The trend in specialty pharmacy is to take an active approach in securing financial assistance for patients whose out-of-pocket responsibility would create a barrier to treatment. Specialty pharmacies employ all services to actively scan the industry for patient assistance through patient access networks or manufacturer assistance programs for qualified patients.

Despite the value-added services provided by specialty pharmacies, stakeholders remain concerned over the fragmentation of care. Collaboration with the patient’s multidisciplinary team is essential to ensure proper utilization of these expensive, but life-changing therapies. 

With a robust biotechnology pipeline, the specialty pharmacy sector is set to remain a growing and dynamic component of the market. Innovative strategies will be needed to continue to ensure appropriate management.

Heather Brand earned her B.A. in Chemistry and PharmD from the University at Buffalo, SUNY.  She worked for an oncology based pharmacy for six years prior to transitioning to a consultant role for a benefits management firm.  She is currently enrolled in the Masters of Science in Pharmacy Business Administration (MSPBA) program at the University of Pittsburgh, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines.  

  1. IMS Institute for Healthcare Informatics.  Medicines Use and Spending in the U.S.  A Review of 2015 and Outlook to 2020. (accessed 2016 May 3).
  2. Schumock GT, Li EC, Suda KJ et al.  National trends in prescription drug expenditures and projections for 2015.  Am J Health-Syst Pharm. 2015; 72:717-36.
  3. Patel NP, Audet PR. A review of approaches for the management of specialty pharmaceuticals in the Unties States.  Pharmacoeconomics. 2014; 32:1105-14.
  4. Kirshenbaum B.  Specialty pharmacies and other restricted drug distribution system: financial and safety considerations for patients and health-system pharmacist.  Am J Health-Syst Pharm.  2009;66(24):s13-s20.

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