What Makes Specialty Infusion Pharmacy So Special?

Specialty infusion pharmacy should be thought of in terms of superlatives, such as most complex and highest cost. From its origins as the first specialized practice of pharmacy, specialty infusion pharmacy has evolved to serve a distinct patient profile within the overarching umbrella that is specialty pharmacy.

Patients who receive care either through specialty pharmacy or specialty infusion pharmacy share a number of characteristics, such as having complex conditions treated with high-cost and complicated medications that require close clinical monitoring. However, it is specialty infusion patients who tend to have conditions that require multidisciplinary health care services.

Infused or injected medications are among the most complicated and often have the most specific management requirements, which include not just product distribution but management of the therapy administration as well. Specialty infusion drugs are distinct because they often require health care professional administration by clinicians with disease and product expertise. Infused therapies are among the costliest medications in the specialty drug category, which comprised 33% of overall drug costs in 2015.1

And the differences go further. Specialty infusion pharmacy is distinct because many new specialty medications are biologics, meaning they are large-molecule medications that require injection or infusion. Additionally, many of these medications require protocols and expertise in the management of hypersensitivity or anaphylactic reactions.

Due to their extreme complexity and cost, specialty infusion drugs require highly specialized services and management for patients to achieve their therapy goals. Delivering these services safely and effec- tively requires seamless, personalized clinical care provided by multidisciplinary teams. The ability to provide expert-led, individualized treatment plans in the home and at alternate treatment sites is what makes it possible for patients, payers, manufacturers, and health care systems to use specialty infusion therapy to achieve optimal outcomes while controlling costs.

Due to the need for expanded health care services beyond medication dispensing, specialty infusion pharmacy is more likely to be covered by private payers under the medical benefit rather than the pharmacy benefit, which is another important distinction from noninfusion specialty pharmacy therapy.


In many cases, when patients are discharged from the hospital, they are responsible for independently following any discharge orders they receive, refilling prescriptions and scheduling follow-up appointments with their physicians. Often, they receive little to no proactive care, save perhaps a follow-up call from the hospital to ask whether they have any questions or concerns.

Alternatively, specialty infusion patients who transition from the hospital or other outpatient site of care to home infusion are admitted on service by a specialty infusion provider who oversees their care. Operating similarly to a hospital without walls, a high-quality specialty infusion provider ensures that patients receive seamless continuity of care in the comfort of their home or an alternate infusion site.

To ensure comprehensive and highly customized clinical management, the patient’s home infusion care team—including a care transition nurse, pharmacist, infusion nurse, and, for patients receiving clinical nutrition, dietitian—meets to review the medication profile, treatment plans, medication-specific protocols, patient comorbidities, and therapy goals. They collaborate with the patient and their caregivers to create an individualized care plan, beginning with education and training to fully explain the process while determining the level of assistance required.

Therapy management includes on-demand and/or dose-administration training visits, as well as collection and review of patient treatment outcomes data. High-quality home infusion providers offer 24/7 access to care, with the ability to speak with a pharmacist or nurse as needed, even at 3 am when the intravenous pump starts beeping or the patient feels ill.

Effective transitions and maintenance of specialized care reduce hospital readmissions, which is of ongoing importance to hospitals, payers, and patients, in terms of quality care and costs.2,3 Health care systems are increasingly recognizing the value of transitioning patients from the hospital to quality home infusion care, which maintains their reach and level of engagement within the community.


While many specialty pharmacy companies contract with nursing agencies to provide care in the home when needed, most specialty infusion providers retain their own multidisciplinary teams of clinicians, including pharmacists, nurses, and dietitians trained in infusion therapy management who follow best practices with consistent processes. These clinicians work closely with the patient’s doctor and other providers to communicate information regarding the patient’s health status and to coordinate changes in medication dose and other care as needed.

For example, Option Care’s specialized hereditary angioedema (HAE) therapy program helps patients with the condition avoid traveling to the emergency department (ED) to treat attacks of severe swelling. When patients call Option Care during an attack, a specially trained nurse travels to the home to provide therapy. The nurse tracks the patient’s response to therapy, determining how long an attack takes to subside, and closely watches for any sign of an anaphylactic reaction. Option Care’s registered nurses are highly trained in HAE to distinguish between an allergic reaction to a medication and a worsening HAE attack that requires treatment with a second dose. All information is reported to the physician, who adjusts the subsequent doses as neces- sary and directs the nurse to administer a second dose if needed.

A study of 158 HAE patients who had 1177 home nursing visits to treat attacks determined that the average response time from the patient’s call to the nurse arriving at the house was 64 minutes, and 76.4% of patients only needed 1 dose of a subcutaneous injection of ecallantide.4 In addition to the quality-of-life benefits, the cost savings of home injection of ecallantide are significant compared with the alternative of receiving care in an ED. Researchers calculated the cost savings of 258 home nurse visits to treat an attack and preventing ED visits as a savings of $632,874 to payers.5

Nurses drive the quality of care in providing complex therapies and engagement with patients facing conditions that are treated with specialty infusion therapies. Even in the case of patient-administered injectable or infused medications, a high level of support is required to ensure that patients are following directions, are compliant with the ordered therapy, titrate doses if necessary, and manage other issues. For example, patients with amyotrophic lateral sclerosis can self-infuse edaravone after being appropriately trained by an infusion nurse; however, because medication is provided cyclically over 10 to 14 days, followed by a 14- to 18-day rest period each 28-day period, patients have intravenous access needs that require personalized clinical home care.

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