Introduction to Specialty Pharmacy
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Questions and Answers

What distinguishes specialty pharmacy from community pharmacies?

  • Specialty pharmacies do not require patient monitoring.
  • Specialty pharmacies dispense over-the-counter medications.
  • Specialty pharmacies manage rare, chronic, and complex medical conditions. (correct)
  • Specialty pharmacies only provide generic medications.

    • Which of the following is a primary reason medications are sent from specialty pharmacies?

  • They have a low cost and are easy to distribute.
  • They require special handling and monitoring. (correct)
  • They are exclusively for preventive care.
  • They are commonly stocked in community pharmacies.

    • What is NOT a component of specialty therapy management?

  • Refill administration
  • Clinical interventions
  • Marketing strategies (correct)
  • Patient education

    • What type of drugs do specialty pharmacies primarily handle?

    <p>Limited distribution drugs (LDDs) (C)</p> Signup and view all the answers

    Which of the following is a role of a specialty pharmacist?

    <p>Managing adverse drug events (C)</p> Signup and view all the answers

    Which medical conditions are typically managed by specialty pharmacies?

    <p>Rare genetic conditions and chronic diseases (D)</p> Signup and view all the answers

    What is involved in the referral management process in specialty pharmacy?

    <p>Benefits investigation and prior authorization (B)</p> Signup and view all the answers

    What is an example of a patient-reported outcome in specialty pharmacy?

    <p>RAPID-3 or SVR scores (A)</p> Signup and view all the answers

    What is the primary role of Patient Assistance Programs (PAPs)?

    <p>To offer free or low-cost medications to uninsured or underinsured patients (A)</p> Signup and view all the answers

    Which of the following is NOT a function of the Specialty Pharmacist?

    <p>Conducting financial audits (D)</p> Signup and view all the answers

    How do Copay Assistance Programs primarily help patients?

    <p>They help insured patients cover their deductibles and copays (D)</p> Signup and view all the answers

    What is one of the key responsibilities of prescribers in specialty pharmacy?

    <p>To document patient outcomes and adherence (D)</p> Signup and view all the answers

    Which organization typically manages Patient Assistance Programs?

    <p>Pharmaceutical companies, nonprofit groups, and government agencies (B)</p> Signup and view all the answers

    What aspect of health care do payors primarily focus on improving?

    <p>Population health improvement (A)</p> Signup and view all the answers

    What is a common requirement for enrolling in Patient Assistance Programs?

    <p>Patients must provide their financial information (B)</p> Signup and view all the answers

    Which of the following statements about specialty pharmacy is TRUE?

    <p>Specialty pharmacists play a critical role in activity related to pharmacovigilance. (A)</p> Signup and view all the answers

    Flashcards

    Specialty Pharmacy Definition

    A practice setting for rare, chronic, and complex conditions with high-cost drugs.

    Main Role of Specialty Pharmacists

    Specialty pharmacists provide drug therapy management and patient education.

    Specialty Pharmacy Workflow

    The process involving referral management, dispensing, and therapy management.

    Stakeholders in Specialty Pharmacy

    Involves patients, pharmacists, physicians, and insurance providers.

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    Financial Assistance Programs

    Programs available to help patients afford specialty medications.

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    Characteristics of Specialty Medications

    High-cost drugs requiring special handling, monitoring, and limited distribution.

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    Common Conditions Treated

    Conditions like RA, HIV, and cystic fibrosis managed through specialty pharmacy.

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    Specialty Therapy Management Tasks

    Includes education, clinical interventions, and adherence monitoring.

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    Adherence/Compliance

    The extent to which patients follow prescribed medication regimens.

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    Pharmacovigilance

    The science of monitoring the effects of drugs after they have been released on the market.

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    Patient Assistance Programs (PAPs)

    Programs providing free or low-cost drugs to uninsured or underinsured patients.

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    Copay Assistance Programs

    Programs that help insured patients afford high medication costs by covering copays.

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    Role of Specialty Pharmacist

    Specialized pharmacists focus on clinical operations, fulfilling prescriptions, and pharmacovigilance.

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    Provider Enrollment in PAPs

    Physicians can register as providers to assist patients in enrolling in aid programs.

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    Eligibility for Copay Assistance

    Criteria that determine who can benefit from copay assistance programs.

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    Financial Information in Applications

    Details about a patient's income and insurance are needed for assistance programs.

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    Study Notes

    Specialty Pharmacy Introduction

    • Specialty pharmacy manages rare, chronic, and complex medical conditions
    • It dispenses high-cost, limited distribution drugs (LDDs)
    • Medications needing special handling and monitoring are dispensed
    • There's no universal definition of specialty pharmacy

    Learning Objectives

    • Define specialty pharmacy practice settings
    • Understand specialty pharmacy workflows
    • Identify key stakeholders in a specialty pharmacy
    • Discuss the roles of a specialty pharmacist
    • List patient assistance programs
    • Identify strategies to become a specialty pharmacist

    Why Specialty Pharmacy?

    • Treats complex, chronic, and rare conditions
    • Medications require specialized dosage, handling, administration, or storage
    • Medications are not commonly stocked in community pharmacies
    • High cost of some medications
    • Monitoring requirements for some medications

    Medical Conditions

    • Inflammatory diseases (e.g., RA, Psoriasis, PsA, AS, UC, Crohn's, AD, eosinophilic asthma)
    • Oncology
    • Infertility
    • Growth deficiency
    • Infectious diseases (e.g., HIV, AIDS, HCV, HBV)
    • Multiple sclerosis
    • Hyperlipidemia
    • Cystic fibrosis
    • Transplant
    • Rare genetic conditions

    Specialty Process Flow

    • The process flow varies based on the specific specialty pharmacy
    • Includes incoming referral, intake process, benefit verification, and insurance investigation
    • Involves contact with providers, verification of medical benefits, and claims submission to pharmacy benefit managers (PBMs)
    • Involves steps like medication shipping and clinical counseling

    Path of a Specialty Pharmacy Rx

    • Referral management
    • Delivery of medication
    • Specialty therapy management
    • Data and analysis

    Referral Management

    • Onboarding
    • Benefit investigation
    • Prior authorization
    • Financial assistance

    Dispensing System

    • Prescription filling
    • Delivery of medication

    Specialty Therapy Management

    • Patient education
    • New-therapy-start
    • Clinical interventions (e.g., adverse drug events management, drug-drug interactions)
    • Refill administration
    • Adherence/compliance

    Data and Analysis

    • Patient-reported outcomes (e.g., RAPID-3, SVR)
    • Adherence/compliance
    • Pharmacovigilance

    The 4 P's of Specialty Pharmacy

    • Patient
    • Prescriber
    • Pharma
    • Payor

    Patient

    • Educate patients about their medication to reduce stress
    • Provide therapy experts for patient questions/concerns
    • Offer financial assistance programs

    Prescriber

    • Provide doctors visibility into their patients' status
    • Investigate health plan coverage
    • Follow up with patients and document treatment outcomes

    Pharma

    • Improve medication compliance and therapy success
    • Prevent therapy disruptions
    • Reduce medication errors

    Payor

    • Support population health improvement
    • Reduce unnecessary fulfillment costs
    • Usually the lowest cost of care setting
    • Enhance risk avoidance

    Specialty Pharmacist

    • Operational responsibilities
    • Clinical responsibilities
    • Fulfillment responsibilities
    • Pharmacovigilance
    • Industry relations
    • Pharmacy liaison
    • Health Economics and Outcomes Research (HEOR)

    Financial Assistance Programs

    • Patient Assistance Programs (PAPs)
    • Copay assistance programs

    Patient Assistance Programs (PAPs)

    • Provide free or low-cost medication to uninsured and underinsured patients
    • Managed by pharmaceutical companies, non-profits, and government agencies
    • Each agency has specific criteria and eligibility requirements

    Copay Cards

    • Also known as copay savings programs or copay coupons
    • Help insured patients afford expensive medications
    • Cover patient's deductible and copay
    • Managed by pharmaceutical companies

    Who's Eligible for Programs?

    • Anyone with private insurance
    • Program restrictions vary
    • Patients must not be insured by Medicare, Medicaid, or Tricare
    • No need to prove financial hardship

    How to Prepare for a Career in Specialty Pharmacy

    • Get involved with student organizations (e.g., NASP, AMCP)
    • Complete a specialty pharmacy APPE
    • Consider pursuing a PGY-1 pharmacy residency

    Post-graduation

    • Complete a PGY-1 pharmacy residency
    • Publish articles related to specialty diseases

    Becoming a Specialty Pharmacist

    • Become a board-certified specialty pharmacist (CSP)
    • Become a subject-matter expert (e.g., oncology, HIV, MS)

    Overall Spend and Volume Trend

    • Specialty medications have seen significant growth in spending over the last decade
    • Projections show continued growth in the specialty medication market segment

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    Related Documents

    Specialty Pharmacy Overview PDF

    Description

    Explore the world of specialty pharmacy, which focuses on managing rare, chronic, and complex medical conditions. This quiz will help you understand pharmacy practice settings, workflows, and the essential roles of specialty pharmacists while also highlighting the challenges and considerations of medication management in this field.

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