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.
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.