What is the future of specialty pharmacy and the impact on the key stakeholders?
Nick: When you look at specialty pharmacy, in my mind it is still an evolving area of pharmacy. Specialty pharmacy really came into being, I would say, at least 20 years ago where it was the very beginning of specialty pharmacy with products like betaseron in the Multiple Sclerosis space, as well as products like Crixivan in the HIV space back in the mid-80s.
The model has evolved and has evolved dramatically over the last 10 years or so. At this point in time, it is really quite dominated by the Big 4, Big 5 large PBMO and health plan owned specialty pharmacies. Therefore, when you look at a model like the one that I represent or CSPN – quite honestly the smaller pharmacies are being shut out of a number of opportunities.
Now, there are a number of good reasons for that. Many retail-based or community-based pharmacies simply have not developed the infrastructure to support a specialty product which, as I mentioned earlier, is a high-touch model. Many of these pharmacies have not developed the benefit investigation needed, the reimbursement support infrastructure needed and really the clinical support needed to truly manage dictation. However in our model, for example, there are a number of community players – smaller, independent pharmacies – that have developed all of these resources. They have also developed accreditation through some of the accrediting groups like URAC and ACHC. As well, they’ve become members of organizations like NASP – National Association of Specialty Pharmacies. So, they have truly developed the model over time.
As I said, the industry is still dominated by the Big 5 and Big 6 and again, I think what’s going to happen over time as this model starts to develop is that you are going to need more pharmacies with the capabilities to handle the special dictation. There are many, many products. Development on the oncology side, for example, on the Multiple Sclerosis side and the Rheumatoid Arthritis side that I think will require a larger group of pharmacies that truly have the capability to manage that patient.
So, that’s where I see it. I see the future of specialty pharmacy really expanding and creating opportunities for stakeholders beyond the few that have truly taken advantage of this space up to this point.
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