Today’s pharmacy is a healthcare destination for people who suffer from sometimes nearly unbearable chronic conditions. These types of patients and their families regularly visit their local chain or community pharmacy for OTC products to relieve their symptoms. But they also look to the pharmacy for education about either the prescriptions they’re taking or to learn of alternatives in the marketplace. They may be okay today, but there’s the nagging question, “Could I feel better?” That question can be addressed by specialty and retail pharmacies working with healthcare teams.
The drugstore proves to be a home away from home for the 133 million Americans1 with rare and chronic diseases. As part of a patients’ healthcare team, pharmacists and pharmacy staff extend a lifeline through a number of services that both retail and specialty pharmacies offer.
What Specialty Pharmacies Do
The specialty pharmacy works with high-cost, high-complexity, and high-touch medication therapies that include oral, injectable, and biologic products for disease states such as MS, rheumatoid arthritis, Crohn’s, and cancers most often administered by physicians. They:
- Store, handle, package, and distribute specialty medications and prepare them for pick-up, shipment, or delivery.
- Offer specialized services to the patient regarding drug administration.
- Often function as a fundamental part of the healthcare team, which means coordinating care with the patient’s physician, pharmacist, nurses, dieticians, and others.
- Provide help and follow-up assistance on insurance coverage, refills, managing side effects, and other needs related to the patient’s medication and general wellness.
- Store, handle, package, and distribute specialty medications and prepare them for pick-up, shipment, or delivery.
Many specialty pharmacies operate as a closed-door physical dispensary (most are owned and operated by retailers, PBMs, and payers) while others may be in clinics, hospitals, and long-term care settings. Some specialty pharmacies are associated with home care services, so that the administration process for the drugs can also be overseen. At the same time, smaller hospitals and urgent care facilities are beginning to maintain a specialty pharmacy on-site.
The majority of specialty business, however, goes through chain drug stores. The patient brings the script to the retail pharmacy, it is entered into the store system, and then goes to the pharmacy’s specialty arm/division, who contacts the patient to ask if home delivery or store pick-up is preferred. And most patients find the option to pick-up in the store helpful because the retail pharmacy is already a frequent stop for their healthcare and everyday needs.
How Retail Pharmacies Help Specialty Patients
People without chronic diseases are blissfully unaware of what it’s like to live under the dark cloud of pain and discomfort that affects every moment of the life of people who have incurable conditions. Some of the most common ones are Crohn’s, diabetes, Irritable Bowel Syndrome, arthritis, and other maladies that can flare up at any moment, keeping one close to a bathroom, or unable to move, breathe, eat, eliminate, or play. So the best way to understand the role of a pharmacy is to understand the needs of the patient and where they are in their journey. Leo Nash, a 58-year-old patient with Crohn’s disease, illustrates his journey and how pharmacies play an ongoing role in his life.
“I had stomach issues starting when I was in high school,” Leo Nash says. “But I wasn’t diagnosed with Crohn’s disease until 2013. So, in a nutshell, I’ve been miserable almost all my adult life.” However, Leo’s diagnosis was a blessing in disguise because the doctors were able to identify his condition as Crohn’s disease. Although it was not good news, it did explain Leo’s ubiquitous discomfort that stems from such symptoms as intestinal bleeding, improper nerve function, and cramping, among other problems arising from this disorder.
The diagnosis provided a starting point from which the GI doctors began with known prescription drugs to handle the disease. Sharon Nash, an RN, and Leo’s wife says, “Leo was given three separate prescriptions over the next year or so, with each trial lasting between two and three months. When none worked, we were both frustrated!” Meanwhile, the couple still had to visit the drugstore to pick up antacids, pain pills, vitamins, and prescribed antibiotics that reduce intestinal bacteria.
Pharmacist and Online Support
“Sharon was determined to get answers,” Leo says. “She not only had the medical background with her nursing, but she would also ask the pharmacists and the hundreds of people in the online forums for advice. I had eating issues, muscle aches, and nutritional losses that made me tired and susceptible to viruses and infections. My disease affected everything the two of us did.” At one point, someone suggested the book Crohn’s and Colitis for Dummies by gastroenterologist Dr. Tauseef Ali, which was published, coincidentally, in the same year Leo was diagnosed, 2013. They were lucky: Dr. Ali’s office was a drivable distance from Leo and Sharon’s home.
After the unsuccessful drug attempts, the Nash’s were told about biologic drugs. Some are self-injected and others are given at a clinic, like the drug Leo uses to this day. Two reasons the clinic was chosen: 1) Dr. Ali was able to get Leo’s insurance to cover the drug and more importantly, 2) it worked. A few weeks after the first infusion of the drug, Leo started to feel some relief. He has been on it for about three and a half years. Yet, the path to the correct prescription is not always so direct as it became for Leo. One company’s formula, delivery system, and frequency offering won’t work for everyone.
Leo and Sharon read the communications material from the manufacturer, including the website copy, brochures, and prescribing information. The website is thorough and has information for doctors and patients alike. “It’s important to read these documents as both prescription and over-the-counter drugs have side effects,” Leo says. “We found even one brand of an over-the-counter antacid provided relief, while another did not. And prescription drug side effects sometimes meant I was unable to use one drug with another, like an antibiotic, for instance.” At the same time, pharmacists often know patients on a first name basis, can assist them with any concerns about medication, and help them get the most from doctor’s appointments.
Leo was fortunate to have an extra assist in his wife. “As a nurse, Sharon was a lifesaver during our many doctor appointments,” Leo says. But also, she had done so much research that she knew the best questions to ask. “We learned to go to our appointments prepared with not only our questions but also with a record of things that had changed, for better or for worse.”
The couple were surprised to learn after a doctor visit that one of the prescribed biologic drugs was not covered by insurance. Fortunately, the drug that was covered is also the one that worked the best for Leo—an infusion of the prescription every eight weeks at a center versus the other drug’s bi-weekly self-injections. Some doctors were especially helpful in finding insurance-approved prescriptions.
It’s All in the “Family”
When one person in a family has an incurable, all-invasive disease—whether it’s a couple or a whole family with children, parents, and grandparents—the entire family experiences the illness together. It is also true that the primary caregiver has much responsibility not only to the patient but also to themselves to stay well. One of the best ways to stay well is by developing a strong communicative relationship among the caregiver, patient, and physician.
The “family” includes the pharmacy (its credibility, brand, layout, and cleanliness), the pharmacist, and the pharmacy staff. The family also extends to the pharmaceutical firm that makes the drug and the doctor who prescribes it. Each member plays a part. The pharmacy carries the vitamins for nutritional deficits that accompany the condition, and they stock cold and hot packs for muscle aches and OTC pain relievers. Plus, pharmacy staff can answer questions or get the answers about different prescription formulas, perhaps translating prescription inserts or online data sheets.
“We are waiting for someone to find a cure, of course,” Leo says. “But in the meantime, it helps to know the pharmaceutical companies are working with the doctors and directly with other people living with Crohn’s. It’s especially comforting to have our local pharmacist help us with all the side issues that accompany the condition.”
Resources:
American Pharmacists Association
Specialty Pharmacy Times July 2018: “What Makes Specialty Infusion Pharmacy So Special?”
https://www.specialtypharmacytimes.com/publications/specialty-pharmacy-times/2018/july-2018/what-makes-specialty-infusion-pharmacy-so-special
MedicoRx® Specialty Pharmacy
https://medicorx.com/what-is-a-specialty-pharmacy/
Drug Channels: The Top 15 Specialty Pharmacies of 2017
https://www.drugchannels.net/2018/03/the-top-15-specialty-pharmacies-of-2017.html
