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February 16, 2022 at 10:06 PM
What You Need to Know
- Some patients use champagne-level drugs when beer-budget generics might work just as well.
- Other patients may need expensive drugs to cope with unusual, complex conditions.
- The author says the patients using those drugs need extra pharmacist support.
Thirty million Americans living with a range of 7,000 rare or orphan diseases require a high level of therapy adherence support, in large part because of the challenges they face if they fail to take the right drugs at the right time: higher medical needs, missed work, early retirement and reliance on caregivers.
A growing number of health insurance agents recognize the value of innovative and effective strategies to address the challenges of managing specialty drugs, which treat complex, chronic or rare conditions and require special administration or handling.
Significantly, the cost for one specialty medication used on a chronic basis is three times the average annual income of Medicare patients. That places specialty medications out of reach for many older adults, or forces them to choose between taking the medicines they need, or buying groceries and paying the rent.
Specialty pharmacies represent a reliable distribution channel for high-cost medications. They offer convenience to the patient and lower costs, while maximizing insurance reimbursements from companies that cover the drugs used.
Patient-First Specialty Pharmacists
Specialty pharmacists focus on providing high-cost, high-touch therapies for patients with chronic, complex diseases. When these professionals take a patient-first approach, they are able to cultivate a deeper relationship with patients, offering personalized information, care insights, and greater support.
With a patient-first model, every decision is about what is best for the patient.
Take for example, a young patient with a rare condition who started a new medication. She was concerned about the unfamiliar side effects. The specialty pharmacist spent 40 minutes listening to all of her concerns and answering all of her questions, rather than rattling off the medication’s usual talking points.
Together, the pharmacist and the patient came up with a plan that involved the patient, pharmacist and physician discussing the new medication in more depth and getting a second opinion. By the end of this process, the patient felt more comfortable with the new medication and was able to remain compliant.
Consider how this contrasts with a retail chain pharmacy, where the focus is more on daily quotas than on comforting patients who are experiencing a difficult time in their lives.
In many cases, specialty pharmacists become almost a part of the patient’s family, listening to and sharing personal stories and developing the kind of relationships that uplift the pharmacist and the patient. This family environment can have a very positive impact on patients.
Health insurance agents should consider patient-first specialty pharmacies the new industry game-changer — and an effective way to cut a plan’s costs without compromising quality for specialty patients.
The Impact of Specialty Drugs
Currently, specialty drugs account for about 17% of the average employer’s overall pharmacy costs.
Experts predict that specialty drug costs will increase annually 21% to 24% over the next few years. In fact, specialty rare diseases have led to substantial direct and indirect economic burdens for the patient, unpaid family caregivers and U.S. health system.
