Specialty pharmaceuticals are defined as "high-cost oral or injectable medications used to treat complex chronic conditions".
Full Answer
What is the largest specialty pharmacy?
Top 15 specialty pharmacies
- CVS Specialty/ Aetna Specialty Pharmacy — $37 billion
- Accredo/ Freedom Fertility/ Cigna Specialty Pharmacy — $30.7 billion
- Alliance Rx Walgreens Prime / Walgreens stores — $19.6 billion
- BriovaRx (owned by UnitedHealth Group's OptumRx) — $16.8 billion
- Diplomat Pharmacy — $4.8 billion
- Humana Specialty Pharmacy — $3.2 billion
What are the types of pharmaceutical drugs?
- (1) Central Nervous System (CNS) Depressants. CNS depressants slow down the operations of the brain and the body. ...
- (2) CNS Stimulants. CNS stimulants accelerate the heart rate and elevate the blood pressure and "speed-up," or over-stimulate, the body.
- (3) Hallucinogens. ...
- (4) Dissociative Anesthetics. ...
- (5) Narcotic Analgesics. ...
- (6) Inhalants. ...
- (7) Cannabis. ...
What are the names of the pharmaceutical companies?
- Mallinckrodt (1867– )
- MannKind (1991– )
- McGuff (1979– )
- McNeil Consumer Healthcare (subsidiary of Johnson & Johnson; 1879– )
- Medac (1970– )
- Medinfar (1970– )
- Melior Discovery (2005– )
- Menarini (????– )
- Merck & Co. (1891– )
- Merck Group (1668– )
What is AAA pharmaceutical?
Since 1986, AAA Pharmaceutical has been a dedicated supplier for the over-the-counter industry. AAA Pharmaceutical markets a wide variety of over-the-counter (OTC) solid-dosage formulations that are comparable to national brands in the following categories:
What are considered specialty pharmaceuticals?
Although there is no accepted definition of specialty pharmaceuticals, they generally are drugs and biologics (medicines derived from living cells cultured in a laboratory) that are complex to manufacture, can be difficult to administer, may require special patient monitoring, and sometimes have Food and Drug ...
What makes a specialty pharmacy special?
A specialty pharmacy manages rare, chronic, and often complex medical conditions that require an increased level of patient management. Typically, specialty pharmacies dispense high-cost, limited distribution medications for which patients may require financial assistance, specific dosing guidance, and counseling.
How is a specialty pharmacy different from a traditional pharmacy?
What is Specialty Pharmacy? While retail pharmacies are for short-term illness, specialty pharmacies work with patients and physicians to provide medications for chronic and more severe illnesses. Specialty pharmacies serve patients with serious health conditions who require complex treatment therapies.
What do specialty drugs treat?
Specialty drugs are high-cost prescription medications used to treat complex, chronic conditions like cancer, rheumatoid arthritis, and multiple sclerosis.
Who is the largest specialty pharmacy?
CVS Health's and Cigna's specialty pharmacies make a slight majority in the nation's revenue share, and the four top companies account for 75 percent of the market share, according to the Drug Channels Institute's estimates released July 27.
Why are specialty pharmacies cheaper?
“The data are clear; specialty pharmacies lower patient costs by preventing hospitals and physicians from charging patients, families, and employers excessively high prices to buy and store specialty medicines themselves.
What are specialty drugs examples?
Specialty drugs are often biologics—"drugs derived from living cells" that are injectable or infused (although some are oral medications). They are used to treat complex or rare chronic conditions such as cancer, rheumatoid arthritis, hemophilia, H.I.V. psoriasis, inflammatory bowel disease and hepatitis C.
What should patients expect from a specialty pharmacy?
Specialty pharmacies provide services that include training in how to use these medications, comprehensive treatment assessment, patient monitoring, and frequent communication with caregivers and the patient's physician or other health care providers.
Can you use GoodRx at a specialty pharmacy?
Use GoodRx to look up prices and discount coupons at Walgreens Specialty Pharmacy and save up to 80% on your prescriptions. Just search for your medication and we will show you the cost at various pharmacies near you along with free coupons to save you money.
How do you know if a medication is a specialty drug?
A specialty medication is a prescription drug that is either a self-administered (non-diabetic) injectable medication; a medication that requires special handling, special administration, or monitoring; or, is a high-cost oral medication.
Why are specialty drugs so expensive?
The high cost of specialty drugs can also be attributed to the special handling they often require: prescription from a specialist, administration by a medical professional in a clinical setting, and significant patient management to make sure the drugs are being used correctly and safely.
What is a non specialty medication?
Specialty Drugs Typically Treat Rare or Complex Diseases In contrast, non-specialty drugs treat both chronic and acute diseases that affect larger populations in the U.S. In contrast to specialty medications, non-specialty drugs are typically small-molecule medications, meaning they are chemically synthesized.
How is a specialty pharmacy different from a traditional pharmacy quizlet?
Specialty pharmacies provide medications to patients only by mail. Specialty pharmacies are all accredited. Specialty pharmacies offer extensive data collection and reporting capabilities.
Why do you want to be a specialty pharmacist?
There are a multitude of reasons why pharmacy students choose to pursue a career in specialty pharmacy. While some may want to work with orphan drugs and others may wish to treat patient populations with rare disease states, many are drawn to the specialty pharmacy by it's potential for growth.
What should you keep in mind about specialty pharmacies?
5 Key Factors to Consider when Selecting a Specialty PharmacyChoose a specialty pharmacy that has experts in complex, chronic conditions.Choose a specialty pharmacy that has resources to assist patients.Choose a specialty pharmacy that has resources to assist your staff.More items...
What should patients expect from a specialty pharmacy?
The specialty pharmacy should be set up to provide a single-point-of-contact (SPOC) for the patient to guide them through their therapy. This SPOC could ensure proactive financial services, as opposed to just offering services once the copay is too high for the patient's income.
What is specialty pharmacy?
A specialty pharmacy is defined not by the site of care but the model of care and the type of services it provides to patients. The Academy of Managed Care Pharmacy (AMCP) defines “specialty pharmacy” as follows: “Specialty pharmacies are distinct from traditional pharmacies in coordinating many aspects of patient care and disease management.
What is the importance of specialty pharmacy?
In the end, what really matter in specialty pharmacy are the services provided to support patient, provider, payer, and manufacturer. The support must be consistent and the systems utilized sophisticated enough to meet the needs of all the constituents. It is not the site of care that is important, but the consistency and quality of the services provided. SPT
Can a pharmacy sell specialty drugs?
Although a majority of the specialty drugs that pharmacies dispense to patients are sold via a specialty pharmacy, any licensed pharmacy can dispense a specialty drug as long as the product can be purchased from a manufacturer or through an authorized wholesale distribution channel.
What's the issue?
Specialty pharmaceuticals are a rapidly growing share of total drug expenditures by public and private health plans. These drugs, typically used to treat chronic, serious, or life-threatening conditions, such as cancer, rheumatoid arthritis, growth hormone deficiency, and multiple sclerosis, are often priced much higher than traditional drugs.
What's the background?
Although there is no accepted definition of specialty pharmaceuticals, they generally are drugs and biologics (medicines derived from living cells cultured in a laboratory) that are complex to manufacture, can be difficult to administer, may require special patient monitoring, and sometimes have Food and Drug Administration (FDA)-mandated strategies to control and monitor their use.
What's The Debate?
Payers are seeking ways to appropriately manage the growing cost of specialty pharmaceuticals. In many cases, the traditional means of influencing drug pricing, such as tiered formularies and drug rebates, are not available for specialty pharmaceuticals because many do not have close therapeutic alternatives.
What's next?
Given that the growth of the specialty pharmaceutical market is expected to continue for many years, discussions about the right balance between cost containment and patient access will continue. These discussions will play out in private forums among payers and specialty pharmaceutical manufacturers.
Resources
Academy of Managed Care Pharmacy, " Concept Series Paper on Specialty Pharmaceuticals ," November 2006.
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What are specialty pharmacies?
Compared to traditional pharmacies, specialty pharmacies can provide more comprehensive services to people with these conditions. These services may begin when you’re diagnosed and continue long after the medication has left the pharmacy. Examples of services may include handling billing and making sure you stay on track with your medications.
How do you choose a specialty pharmacy?
Typically, your insurance company will have a preferred special ty pharmacy network that you’ll use. You may have a few different specialty pharmacy options, or you may have just one. It varies based on your insurance plan. Healthcare providers may also have a certain pharmacy that they will refer you to.
What types of medications do specialty pharmacies dispense?
Specialty pharmacies mainly deal with medications that treat complicated or rare health conditions. These are known as specialty medications.
What is referral pharmacy?
A referral provides a specialty pharmacy with more complete information about your background. This helps them know if a medication is safe for you. They’ll use your insurance information provided to find out if the medication is covered.
Why do medications need prior authorization?
Many of these medications need prior authorizations because they’re so expensive. Even if the insurance company covers it, your copay may still be quite high.
What does a pharmacist do before dispensing a medication?
Before dispensing a medication, a retail pharmacist checks for allergies and drug interactions. They also make sure the medication is safe based on your age, medical condition (s), and other factors.
Do specialty medications need special storage?
As mentioned above, specialty medications may require special storage. This may include making sure the medication stays cold until you receive it. Specialty pharmacies have the proper equipment to make sure your medication stays at the right temperature.
What is specialty pharmacy?
Specialty pharmacy is a loosely defined term. Generally speaking, specialty drugs are expensive, outpatient drugs that treat rare and complex conditions , such as HIV, autoimmune diseases, and organ transplant patients. They often require special handling, such as refrigeration, and patients frequently need additional support (e.g. prior authorization, financial assistance, education) to access their medications, adhere to their drug regimen, and manage side effects.
What does the specialty pharmacy business look like for health systems?
When health systems talk about getting into the specialty pharmacy business, they're generally referring to buying and selling patient-administered outpatient drugs that are covered under patients' pharmaceutical benefit (as opposed to the medical benefit). Many health systems start in specialty pharmacy by dispensing oral oncolytics or Hepatitis C drugs, which are often open-source and so don't require specialty pharmacy accreditation to buy and dispense. Others would argue that those models don't meet the bar for specialty pharmacy, but that instead true specialty pharmacies are accredited by one or more agencies and can access the full-array of specialty drugs, including limited-distribution drugs.
Why is specialty pharmacy a hot topic right now?
Specialty pharmacy gets a lot of attention because of the drugs' high prices. Although pharmacies typically only mark-up drug prices by a few percentage points, the profits can be significant because the drug acquisition costs are so high.
How many health systems have a specialty pharmacy?
According to the American Society of Health-System Pharmacists' 2016 national survey of pharmacy practice, 8.7% of hospitals have a specialty pharmacy operation. Not surprisingly, larger hospitals are more likely than smaller ones to be in the specialty pharmacy business.
Why is a health system owned pharmacy important?
Unlike a third-party specialty pharmacy, a health system-owned specialty pharmacy can more easily gain access to the patients' medical records and care team, thus providing increased care continuity and better service for patients and prescribers. This is a major advantage for acutely ill patients whose medications or dosing may need to be changed on a week by week basis. It also has the potential to help increase patient adherence.
Do specialty pharmacies have to be accredited?
Others would argue that those models don't meet the bar for specialty pharmacy, but that instead true specialty pharmacies are accredited by one or more agencies and can access the full-array of specialty drugs, including limited-distribution drugs.
Do drug manufacturers collect data?
Drug manufacturers are eager for data on utilization of their specialty drugs and patient outcomes, and health systems have the potential to collect more data than third-party specialty pharmacies. Thus there is a potential for partnership.
How much does a specialty drug cost?
Specialty drugs are very expensive – often $1,000 or more per month – and spending on them is growing 15 to 20 percent a year. Many prescription drug plans that cover specialty drugs have a separate “tier” that specifies how much an individual has to pay for specialty drugs.
How is a specialty drug covered?
How a specialty drug is covered usually depends on where the patient receives the drug. If the patient takes a pill or self-injects the drug at home, it is more likely to be covered through his or her prescription drug benefit. If the patient receives the drug at a doctor’s office or an outpatient clinic, it’s more likely to be covered through ...
Do you have to pay a percentage of a drug?
Individuals may be required to pay a percentage of the drug cost or a flat-dollar copay. Copays are fairly rare for specialty drugs (it’s more common for plans to require patients to pay a percentage of the cost instead), but when they are used, they tend to be several hundred dollars.
What is specialty drug?
Specialty drugs or specialty pharmaceuticals are a recent designation of pharmaceuticals that are classified as high-cost, high complexity and/or high touch. Specialty drugs are often biologics —"drugs derived from living cells" that are injectable or infused (although some are oral medications). They are used to treat complex or rare chronic ...
What is a specialty medication?
Specialty pharmaceuticals are defined as "high-cost oral or injectable medications used to treat complex chronic conditions".
How much did the price of specialty drugs increase in 2013?
Price increases by therapeutic category ranged from 1.7 percent to 77.2 percent ."
Why are specialty drugs so expensive?
In addition, there are often fewer drug choices for rare or hard-to-treat diseases. This results in less competition in the marketplace for these drugs due to patent protection, which allows these firms to act as monopolists (See Drug Price Competition and Patent Term Restoration Act ). Due to this lack of competition, policies that serve to limit prices in other markets can be ineffective or even counter-productive when applied to specialty drugs.
How much does a specialty drug cost?
High-cost medications are typically priced at more than $1,000 per 30-day supply. The Medicare Part D program "defines a specialty drug as one that costs more than $600 per month".
When did Randy Vogenberg start investigating specialty drugs?
When Randy Vogenberg of the Institute for Integrated Healthcare in Massachusetts and a co-leader of the Midwest Business Group initiative, began investigating specialty drugs in 2003, it "wasn't showing up on the radar". By 2009 specialty drugs had started doubling in cost and payers such as employers began to question. Vogenberg observed that by 2014 health care reform had changed the landscape for specialty drugs. There is a shift away from a marketplace based on a predominately clinical perspective, to one that puts economics first and clinical second. : 15
Why are drugs considered specialty?
Drugs are often defined as specialty because their price is much higher than that of non-specialty drugs. Medicare defines any drug for which the negotiated price is $670 per month or more, as a specialty drug which is placed in a specialty tier that requires a higher patient cost sharing.
What is special about specialty pharmacy?
A specialty pharmacy is a very specific way to provide specialty drugs to a patient population who requires complicated services and extensive care.
How much does a specialty medication cost?
Centers for Medicare and Medicaid Services (CMS) For lack of a better definition, CMS Part D drug benefit defines a specialty medication as a drug with a minimum monthly cost of $670 and requires a higher cost share for the patient.
Why do specialty medications require special handling?
Due to the molecular complexity of a specialty medication, they sometimes require special handling. When technicians or pharmacists are preparing these medications for administration, they are often required to wear protective gear such as nitrile gloves or safety goggles. The medications may also be temperature sensitive and require special handling through the shipping process such as refrigeration or freeze protection.
How much is specialty medicine spending?
In the next 5 years, specialty medications are predicted to account for 50% of overall drug spending, approximately $250 billion. As research into rare and complex diseases continues, more specialty medications are reaching the market.
How many specialty drugs are there?
In the mid-1990’s, fewer than 30 specialty medications existed, whereas there are currently more than 300 specialty drugs on the market. Currently, most drugs in the pipeline are specialty pharmaceuticals, particularly oncology agents.
What are biologic medications?
Biologic medications include blood components, cells, allergens, genes, tissues, and recombinant proteins. A specialty medication can be self-administered at home or may administered by a health care professional in a physician’s office, clinic, infusion center, or an outpatient hospital.
Is there a universal definition of specialty medication?
Although the development of, and health care spending on, specialty drugs has increased over the past decade, there is no universally accepted definition of a specialty medication. A specialty pharmaceutical differs from other medications for many reasons.
What is a pharmaceutical sales representative?
All pharmaceutical sales representatives are experts on their company’s product lines and their target audiences’ needs. They start by meeting with physicians in clinics or hospitals to discuss product details, field any questions, and compare their product to others on the market.
What is a specialty rep?
Specialty pharmaceutical reps serve a narrower range of specialists trained in a specific field, rather than primary care providers. Johnson & Johnson Pharmaceuticals, for example, is developing products for cardiovascular and metabolism, immunology, neuroscience, oncology, and pulmonary hypertension, all of which fall under specialty categories.
What percentage of pharmaceutical sales reps say base pay increases had a positive impact on their 2019 compensation?
The majority of pharmaceutical sales reps (74%) say base pay increases had a positive impact on their 2019 compensation. Pay raises could point to appreciation from leadership or even the company’s attempt at keeping reps satisfied in a competitive job market.
What's The Issue?
What's The background?
- Although there is no accepted definition of specialty pharmaceuticals, they generally are drugs and biologics (medicines derived from living cells cultured in a laboratory) that are complex to manufacture, can be difficult to administer, may require special patient monitoring, and sometimes have Food and Drug Administration (FDA)-mandated strategie...
What's The Debate?
- Payers are seeking ways to appropriately manage the growing cost of specialty pharmaceuticals. In many cases, the traditional means of influencing drug pricing, such as tiered formularies and drug rebates, are not available for specialty pharmaceuticals because many do not have close therapeutic alternatives. COST SHARING: Payers are employing a variety of tools to control cost…
What's Next?
- Given that the growth of the specialty pharmaceutical market is expected to continue for many years, discussions about the right balance between cost containment and patient access will continue. These discussions will play out in private forums among payers and specialty pharmaceutical manufacturers. They will also spill into public debates over the role of governme…
Resources
- Academy of Managed Care Pharmacy, "Concept Series Paper on Specialty Pharmaceuticals," November 2006. Bartholow M, "Top 200 Drugs of 2012," Pharmacy Times, July 17, 2013. Centers for Medicare and Medicaid Services, "National Health Expenditure Projections 2011-2021," January 2012. CVS Caremark, "CVS Caremark Insights 2013: Drug Trend and Key Issues in Phar…
About Health Policy Briefs
- Written by Ian Spatz Senior Adviser Manatt Health Solutions Nancy McGee Managing Director Manatt Health Solutions Editorial review by Troyen A. Brennan Executive Vice President and Chief Medical Officer CVS Caremark Ernst Berndt Louis E. Seley Professor in Applied Economics Sloan School of Management Massachusetts Institute of Technology Rob Lott Deputy Editor Health Af…