Specialty Pharmacy Overview PDF

What’s So Special About Specialty Pharmacy? An introduction to specialty pharmacy practice Yousef Toma, Pharm.D., CSP, AAHIVP Assistant Professor of Pharmacy Practice DATE Learning Objectives 1. Define specialty pharmacy practice setting 2. Understand specialty pharmacy workflow 3. Identify speci...

What’s So Special About Specialty Pharmacy? An introduction to specialty pharmacy practice Yousef Toma, Pharm.D., CSP, AAHIVP Assistant Professor of Pharmacy Practice DATE Learning Objectives 1. Define specialty pharmacy practice setting 2. Understand specialty pharmacy workflow 3. Identify specialty pharmacy stakeholders 4. Discuss roles of a specialty pharmacist 5. List financial assistance programs available for the patients 6. Identify strategies to becoming a specialty pharmacist Specialty Pharmacy No universal definition of specialty Manages rare, chronic, and complex medical conditions Dispenses high-cost, and limited distribution drugs (LDDs) Dispenses medications that require special handling, and special monitoring Why do medications have to be sent from a specialty pharmacy? Treat complex, chronic, and/or rare conditions Special dosage, handling, administration, or storage LDD status Not commonly stocked in a community pharmacy Cost Monitoring requirements Medical Conditions Inflammatory diseases Infectious diseases RA, Psoriasis, PsA, AS, HIV, AIDS, HCV, HBV UC, Crohn’s, AD, Multiple sclerosis eosinophilic asthma, etc. Hyperlipidemia Oncology Cystic fibrosis Infertility Transplant Growth deficiency Rare genetic conditions Specialty Process Flow Path of a Specialty Pharmacy Rx Specialty Referral Delivery of Data and Therapy Management Medication Management Analysis Referral Management Onboarding Benefits investigation Prior authorization Financial assistance Dispensing System Prescription filling Delivery of medication Specialty Therapy Management Patient education New-therapy-start Clinical interventions Adverse drug events management Drug-drug interactions Refill administration Adherence/compliance Data and Analysis Patient-reported outcome RAPID-3, SVR, etc. Adherence/compliance Pharmacovigilance The 4 P’s of Specialty Pharmacy Patient Educate patients on medication to decrease stress associated with the diagnosis Therapy experts available for patients' questions/concerns Help patients with financial assistance and/or foundations available to suit their needs Prescriber Provide doctors visibility into their patients' status Handle the investigation of the patients' health plan coverage Follow up with patients and document outcomes and adherence to share with the provider Pharma Help to improve medication compliance and therapy success Help prevent disruption in patients' therapy Help to reduce medication errors & drug related problems Payor Help with population health improvement Reduce unnecessary fulfillment costs Are usually the lowest cost of care setting Help with risk avoidance Specialty Pharmacist Operation Industry relation Clinical Pharmacy liaison Fulfilment HEOR* Pharmacovigilance Financial Assistance Programs Patient Assistance Programs Copay Assistance Programs Patient Assistance Programs (PAPs) PAPs – What are they? Provide free or low-cost drugs to patients with no health insurance and those who are underinsured Managed by pharmaceutical companies, nonprofit, and government agencies Each agency/company has specific criteria and eligibility requirements Who can access PAPs? A physician can register as a provider A patient can enroll on their own Might need information from their provider Specialty pharmacy’s financial assistance department can enroll the patient Application Overview Patient demographics Provider information Prescription information Patient’s income/financial information Insurance information Examples of PAPs Gilead Advancing Assistance Program PAN Foundation Novo Patient Assistance Program Pfizer Patient Assistance Program Leukemia and Lymphoma Society (LLS) Manufacturer Copay Assistance Programs Copay Cards – What are they? Also known as copay savings program, or copay coupon Help insured patients afford expensive drugs Covers patient’s deductible and copay Managed by pharmaceutical companies Who’s Eligible? Anyone who has private insurance Program restrictions vary Patient must not be insured by Medicare, Medicaid, or Tricare Patient doesn’t have to prove financial hardship  Copay Card Example Diagnosis: mod-sev RA Medication: Xeljanz (tofacitinib) Health insurance: OptumRx (private insurance) How to Prepare for a Career in Specialty Pharmacy? Overall Spend and Volume Trend During Pharmacy School Get involved with students’ organizations: NASP (National Association of Specialty Pharmacy) AMCP (Academy of Managed Care Pharmacy) Complete a specialty pharmacy APPE Post-graduation Complete a PGY-1 pharmacy residency Publish articles related to specialty diseases Specialty Pharmacist Become a board-Certified Specialty Pharmacist (CSP) Become a subject-matter expert Oncology: BCOP HIV: AAHIVP MS: MSCS Yousef Toma, Pharm.D., CSP, AAHIVP [email protected]