Danbury, CT — The next big shift in healthcare experience may be happening at the pharmacy – but not a pharmacy you’ll ever see in person. IMS recently reported that speciality pharmacies now account for 1/3 of all healthcare spending. That’s up from 19% a decade ago and predicted to rise to 50% in the next ten years.
Speciality pharmacies dispense the kinds of niche drugs that are too expensive to keep stocked at every neighborhood pharmacy. These drugs typically cost tens or hundreds of thousands of dollars per year and treat complex diseases like cancer, rheumatoid arthritis, hemophilia and H.I.V.
The promise of these pharmacies is simple: They can save health plans money by delivering some of the concentrated services that these patients need (like injection training) and potentially keep them adherent longer. For many patients, that opportunity to have a nurse show them how to inject or reconstitute a complex drug is critical to helping them become at-home healthcare providers for themselves or a loved one.
But, because some of the most expensive drugs are filled by specialty pharmacy, it’s also where insurers are focusing their cost cutting levers, like cost sharing, step edits, pre authorizations and more. In an era of high deductible plans and over-worked front office staff at practices, those levers can make getting the drugs they need feel impossible for some.
Working with these pharmacies can come with burdens beyond the costs, like waiting for prescriptions to be delivered by mail each month (often within days of the last one running out) and confirming each month’s renewal by phone. For some drugs that require refrigeration that mail delivery can be even more difficult – requiring someone to sign for the delivery in person.
The New York Times recently interviewed a mother named Megan Short whose daughter, Willow cannot afford to miss even a single dose of a drug she takes daily to prevent her body from rejecting her transplanted heart. Due to the rules of her plan, Short can’t get a refill until each month’s supply is three quarters gone. From there, it takes seven days for the refill. “You just feel like every month, you’re hoping that they don’t mess it up,” she told the Times.
Often, patients also have very limited choice in a specialty pharmacy provider. Insurers may limit them to as few as one preferred provider. Or, a manufacturer may only distribute their product through a few networks.
While other industries are hiding their complexity and giving consumers almost unlimited choices, one of the fastest growing channels of healthcare experience is adding complexity and limiting choice. These gated pharmacies are also standing in stark contrast to the changing experience of retail pharmacies where consumers can order by app, drive through, chat with a nurse, or even receive complete primary care.
Speciality pharmaceutical manufacturers have a role to play in setting patient expectations and potentially even creating concierge or fast-pass services for their patients. In the competition for time and attention today, healthy behaviors rarely get first place – especially when their walled off, expensive, and difficult to understand.