Is the specialty pharmacy model a win/win for all stakeholders? Basically, who wins and who loses as the industry grows?
Nick: That’s a very interesting question and sort of a future thought kind of question. When you think about specialty pharmacy, there are two wins, if you will. I think the patient ends up winning because they will get a higher degree of care in these higher touch models, whether it be through central fill – which is perfectly appropriate for some patients – or the community-based and even higher touch face-to-face model that we are working with and developing. I think the patient is a big winner in that space.
I think the provider is a big winner in this space. Again, the provider is a specialty. I’ll take a very specific example in the oncology community. As more and more products move away from infused therapy and move more into oral therapy, the provider needs an adjunct to the healthcare team in order to keep the patient on therapy and successful in their therapy. Side effect management, etc. Again, that’s where the specialist will win in using a specialty pharmacy as an adjunct to his practice.
I think the managed-care organizations are also quite honestly the winners in this space. The organization that ultimately is paying the bill --- well, the employer is paying the bill. But through the managed-care organization, they are winners as well because again you are getting patients compliant to therapy, staying on therapy and being successful on therapy. Ultimately, the goal is to reduce abandonment of therapy or short duration of therapy before you truly make a difference. Again, a very specific example of that would be in the Hepatitis B space where the duration of therapy is so important in achieving a response that can be sustained over time.
Finally, I want to mention the manufacturing community. Again, I think they win in this environment because they are able to promote their product, they have a higher degree of understanding that the patient that is on their therapy is going to be successful on therapy and compliant on therapy. Obviously, that means that they are marketing and selling the product that they have spent millions of dollars in getting to market in the first place. In my mind, everyone kind of wins in the specialty pharmacy model.
You say “Who loses?” I think the only way you lose in this model is if you don’t create a little bit more diversity in the model so that you don’t have as much fragmentation within the model and that the standard of care is consistent across all the different types of models, whether it is central fill or community based, etc. To keep that standard of care high and you basically maintain or retain the notion that specialty pharmacy was created as a high-touch model focusing in on intense counseling of the patient with the overriding goal of keeping the patient on therapy and managing their side effects.
As long you stay true to those basic tenets and don’t allow specialty pharmacy to turn into a quote/unquote “mail order” type of operation, then I think obviously all of the stakeholders I mentioned win. But, if you don’t maintain those, then I think really all the stakeholders end up losing in the end.
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