Specialty Pharmacies Fill a Critical Role in Treating Complex Illness

Most of the more than 4.75 billion prescriptions filled in retail pharmacies in 2022 were off-the-shelf medicines in standard dosages.

“For medications that treat a common condition like an ear infection, retail pharmacies are typically the best option,” said Randy Falkenrath, president of specialty pharmacy at Elevance Health’s pharmacy benefit manager, CarelonRx. “However, when a patient is experiencing a complex or chronic condition such as cancer, they often require specialty medications. These drugs can be high cost, require special handling or administration, and the patient may need ongoing clinical support, which is where specialty pharmacies come in.”

Nora knew of several retail pharmacies in her area, but she was not familiar with any specialty pharmacies. She appreciated that her doctor gave her a list of them. Several of the specialty pharmacies are stand-alone stores, and two are part of hospitals in her area. While most retail pharmacies advertise directly to consumers in their area, specialty pharmacies work directly with and through care providers to reach their customers, which is most likely why she wasn’t familiar with them.
 

What is a Specialty Drug?

Specialty drugs are medications used to treat complex illnesses. They can treat health conditions such as cancer, hemophilia, rheumatoid arthritis, and cystic fibrosis. They can also help prevent rejection of an organ transplant.

Some specialty drugs can be taken by mouth. Others require a care provider to deliver them intravenously (by IV) or by injection. Specialty medications are often costly — a single treatment can exceed $10,000, and annual costs can run well over $100,000. In 2022, specialty medications accounted for 55% of the total drug spend in the United States.
 

What Should People Expect from a Specialty Pharmacy?

Nora soon learned that specialty pharmacies provide support that goes well beyond distributing specialty medications. Highly skilled pharmacists, nurses, and care providers who work in specialty pharmacies often have additional, advanced certifications and education. They play a major role in supporting the patient — and at times that person’s caregiver.

“The diagnosis and subsequent process for getting started on specialty medications can feel both unfamiliar and overwhelming,” Falkenrath said. “At a specialty pharmacy, our service goes far beyond getting the medication to our patients. We want to make sure they feel comfortable taking their prescribed medication as directed and they have easy access to a knowledgeable specialty pharmacist to address their concerns.”

Specialty pharmacies provide a high level of service, typically including an evaluation by a pharmacist who knows the medications well, training for the patient on how to administer the medication (which could include instructions on how to inject a medication into the body), information on managing potential side effects, and significant time spent ensuring the patient can ask as many questions as needed.

Nora’s specialty pharmacy gave her intensive, individualized services including: 

• Availability. 24 hours a day, seven days a week. A complex illness does not abide by business hours. Nora could reach someone at the specialty pharmacy at any time of day or night to discuss symptoms and side effects, address concerns, and get answers tailored to her experience. Being available around the clock allows the specialty pharmacy team to be hyper-responsive to their customers’ needs and changing conditions.
  
  
• Educational support. Nora did not ask many questions when she was diagnosed because she was so stunned. As she worked with the specialty pharmacy team, she grew more comfortable asking questions during every phase of her treatment. Specialty pharmacies provide initial and ongoing information on the specialty drugs they dispense. They partner closely with patients and their caregivers, working with them to detect any issues early so they receive safe and effective treatment. Following and maintaining the medication schedule is crucial for treating people with complex illnesses, so the specialty pharmacy team works collaboratively with their patients to encourage adherence.
  
  
• Coordination with physicians. Nora had no idea how much work her specialty pharmacy team was doing on her behalf behind the scenes. Specialized team members assembled data from multiple sources and distilled it into a robust picture of her unique needs. The specialty pharmacy team is an important part of the care team, maintaining close communication with other care providers. They work cooperatively to administer the specialty medications best suited to their patients to achieve the best outcomes possible.
  
  “Specialty pharmacists coordinate dose modifications with the prescriber, monitor the patient’s lab results and symptoms, and continue to customize the specialty medications for each individual,” Falkenrath said. “They can recommend ways to mitigate side effects or change doses if a patient isn’t reacting well to their current treatment

• Administrative help. Removing administrative burdens allowed Nora to focus on her health. Her specialty pharmacy team secured the prior authorizations and identified benefits coverage from her health plan. They even identified financial resources to help Nora offset the cost of her specialty medications.

Specialty pharmacies help patients and caregivers navigate the rapidly evolving landscape of specialty medications, which continues to expand to treat a range of complex illnesses. In reducing the expense of often costly therapies and expanding patients’ access to healthcare professionals, specialty pharmacies boost both adherence and safety. Most importantly, they offer around-the-clock support for people managing complex illnesses and conditions.