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What's So Special About Specialty Pharmacy?

Submitted by admin on Tue, 12/01/2020 - 08:56
Specialty Pharmacist Blog

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First, what exactly is Specialty Pharmacy?

Specialty pharmacy can be defined in many ways. The National Association of Specialty Pharmacy (NASP) defines it as "Specialty Pharmacy's patient-centric design provides a comprehensive and coordinated model of care for patients. The medications and expert services that specialty pharmacies provide expedite patient access to care, ensure appropriate medication use, and achieve superior clinical and cost-effective outcomes." (nasp.org) Yet, Medicare uses a monthly cost of $670 or greater to designate a specialty medication. To add more confusion to the mix, The Academy of Managed Care Pharmacy (AMCP) points out distinctions of specialty to traditional pharmacy services with "Specialty pharmacies are distinct from traditional pharmacies in coordinating many aspects of patient care and disease management. They are designed to efficiently deliver medications with special handling, storage, and distribution requirements with standardized processes that permit economies of scale. Specialty pharmacies are also designed to improve clinical and economic outcomes for patients with complex, often chronic and rare conditions, with close contact and management by clinicians." https://www.pharmacytimes.com/publications/specialty-pharmacy-times/2013/nov_dec-2013/what-is-a-specialty-pharmacy

So, what is the correct definition and how do we further interpret this?

Really, they are all correct as there is not one single source of truth for the definition. Specialty pharmacies do all the services noted above for those patients that are chronically ill, covering a wide range of disease states and the costs of these medications can vary greatly. However, not all specialty pharmacies operate in the same way. Some specialty pharmacies can support all the disease states and service all 50 of the United States, while others might be more disease state focused or with just a regional ability to dispense. The differences in specialty pharmacies, the disease states they serve, and the associated definitions take on many shapes and sizes and is perhaps the reason it is so difficult to agree on one definition.

GROWTH
One thing that everyone seems to agree on is that specialty pharmacy is growing!

"Growth in revenue for specialty drugs is outpacing the growth in revenue for traditional drugs," according to data from IQVIA, and "U.S. specialty pharmacy industry revenues have grown from 34.9 percent of the pharmacy industry in 2014 to 45.4 percent in 2018", June 1, 2020.

The continued development of therapies for the chronic disease states has led to much of the growth in the specialty pharmacy segments.  These new drugs often require a higher tracking of patient clinical data, side effects and outcomes, all of which fall into the services that specialty pharmacies are designed to support.

TESTIMONIAL

"Growth in revenue for specialty drugs is outpacing the growth in revenue for traditional drugs," according to data from IQVIA, and "U.S. specialty pharmacy industry revenues have grown from 34.9 percent of the pharmacy industry in 2014 to 45.4 percent in 2018"

DATA FROM IQVIA
June 1, 2020

Specialty Building Blocks

How does Specialty fit into 340B?

Specialty pharmacies can also act as a 340B contract pharmacy, rendering savings for qualified patients back to the covered entity.  Because the costs of these medications are typically higher than in traditional retail pharmacy, the savings may also be greater.  As with any 340B contract pharmacy relationship, the covered entities must choose pharmacies that are being utilized by their patients to render savings back to their 340B program.

Covered Entities that have their own in-house specialty pharmacy may also support the entities’ 340B savings programs.  Whether an in-house or a contract pharmacy, the covered entity must ensure that proper policies and processes are in place to support the compliance of their 340B program.

Why is Specialty important to Covered Entities?

As specialty continues its upward market share of pharmaceutical spending, it will be a focal area for Covered Entities participating in 340B to include in their 340B programs.  Since more drugs will be specialty in the years to come, covered entities will be able to capture savings for qualified patients using these medications when contracted with specialty pharmacies.  Covered entities that have not already started to build a specialty contract pharmacy network may want to consider doing so to help their 340B program continue to thrive in the future.

For more information on how we can help, contact us or read more about Specialty.

 

The content in this blog is for informational purposes only and is not intended to be used in place of regulatory guidance. The opinions and views expressed herein are those of the authors and do not necessarily reflect the official position or opinions of SUNRx or any regulatory authority. Furthermore, some content may contain copyrighted material, the use of which has not always been specifically authorized by the copyright owner, but which we believe constitutes a "fair use" of any such copyrighted material as provided for in Section 107 of the US Copyright Law. We are making the information herein available in our efforts to advance understanding of the 340B program and its offerings. These views are always subject to change, revision, and rethinking at any time and may not be held in perpetuity.

Cary Green and Donna Petty
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The 340B Drug Discount Program requires drug manufacturers to provide significant discounts.

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Submitted by admin on Thu, 12/03/2020 - 12:16

Updates from our experts on the latest in the industry.

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  • Julie Jennings

    Vice President, Operations

    With a penchant for building teams and structure from the ground up, Julie drives operational efficiency in creative ways to ensure SUNRx remains current, compliant, and client-focused. As Vice President of Operations, Julie leads teams comprised of implementation managers, operational business analysts, operations analysts, wholesaler coordinators, and accounting associates.

    With more than 30 years of experience in healthcare and inventory management, Julie specializes in project management, data analysis, account management, and product development. Julie has successfully managed diverse portfolios, from the hospital industry to Fortune 100 clients.

    Julie has a bachelor’s degree from the University of Notre Dame and holds a certificate in Business Computing Applications from University of California San Diego and a certificate in Project Management from Villanova University.

  • Sanjay Joshi

    Vice President, Technology

    Sanjay leads the Engineering, Product, and IT Operations teams at SUNRx where he oversees product development, delivery, support, and data engineering. With over 25 years of experience in IT, healthcare and eCommerce, Sanjay brings B2B and B2C digital expertise that extends across cloud computing, SaaS, and mobile applications. His experience spans from Big Five tech companies to the Malaysian government to small start-ups, conceptualizing and implementing groundbreaking ideas and aligning technology investments with strategic goals. Inspired by his passion for technology and people, Sanjay has been building and retaining world-class global engineering teams, pioneering cloud adoption, and launching data engineering initiatives over the past decade.

    Prior to joining SUNRx, Sanjay led the Software and Data Engineering, Product, and IT Operations teams at MedImpact Direct. He has a master’s degree in computer science, MBA in Technology Management, Blockchain certification from Massachusetts Institute of Technology, and is certified as a Project Management Professional (PMP).

  • Jacqueline Artinger

    Vice President, Compliance

    With a firm belief that everyone has a role in compliance, Jacqueline (Jackie) Artinger is committed to promoting compliant practices within all levels of SUNRx and supporting information sharing with SUNRx’s Clients and partners to make compliance easier for them as well. As Vice President of Compliance, she leads a dedicated Compliance Manager, who together, work diligently to stay on top of the long-standing 340B program requirements and pivoting quickly to respond to significant changes, such as the recent manufacturer restrictions, to enable the 340B Covered Entities to make decisions as quickly as possible. She is also able to use her legal experience to quickly assess issues and drive forward to resolution while maintaining compliance and meeting business needs.

    Prior to SUNRx, Jackie brings over 35 years of combined experience from her practice as a technician in clinical and outpatient pharmacy settings and as an attorney dedicated solely to the area of healthcare law working for nationwide pharmacy benefit managers.  During her 10+ years at SUNRx’s parent company, MedImpact Healthcare Systems, Inc., Jackie’s work included being the dedicated legal counsel for SUNRx. She takes great satisfaction helping safety net providers in their quest to best serve their patients. Jackie has been a member of the State Bar of California since 1998, has a law degree from Western State University College of Law (with distinction) and an Associate Degree in Pharmacy Technology from Orange Coast College. She is a published author (Pharmacy Law Desk Reference, Haworth Press (2006) Chapter 12: “Requirements of a Contract; Anatomy of a Sample Contract”) and has provided training on healthcare issues both on local and national levels. 

  • Donna Petty

    Managing Principal, Account Management

    As Managing Principal of Account Management, Donna leads client-facing teams and fosters partnerships that help clients maintain and grow their 340B savings through SUNRx’s networks, products, and services.

    Donna joined SUNRx in 2020 and served as the Principal of Specialty Programs, aligning the operations of the SUNRx Specialty Pharmacy 340B program with the nuances of specialty pharmacy. Prior to joining SUNRx, Donna served as the Sr. Director of Program and Account Management for Hospital/Health Systems at Diplomat Specialty Pharmacy, where she set up the pharmacy’s 340B program, supported client retention and growth, and led client-facing teams that supported over 150 covered entity relationships. She began her pharmacy career at St. John Health System in Detroit as the Business Operations Manager for their 19 pharmacy chains and has worked with 340B in many capacities since 2001.

    Donna has a master’s degree in business administration from Central Michigan University, a bachelor’s degree from Northwood University, and is an Apexus certified 340B ACE. 

  • Eric Little

    VP, Operations

    Eric Little leads the Implementations, Client Services and Operations departments for SUNRx. Prior to this role, Eric worked for SUNRx’s parent organization, MedImpact, where he served in various leadership roles in Government Programs and Services (GPS), Enterprise Effectiveness and Corporate Development.

    Eric is a retired Navy Commander with a 24 year naval career and received a bachelor’s degree from the U.S. Naval Academy in Annapolis, MD, and a master’s degree in Global Business Leadership from the University of San Diego. He also holds a Graduate Certificate in Project Management from the University of San Diego.