A new coalition of patients, caregivers, physicians and pharmacy experts is advocating for access to specialty pharmacies, according to the group, the Specialty Access Alliance. It says it wants to educate policymakers about patients with complex, chronic and rare conditions and the pharmacies that serve them.
The alliance released a report that counts more than 1,900 accredited specialty pharmacy locations, with health systems operating 553, or 28%. It says no national count of specialty pharmacy users exists. In a Colorado claims study it cites, 0.8% of people with a full year of coverage filled at least one prescription at a specialty pharmacy, and those patients took nearly twice as many different medicines as other pharmacy users.
The report points to studies linking specialty pharmacy care to better adherence and faster starts. In a randomized trial, tailored pharmacist support raised median 12-month adherence to 93% from 87%, and among patients on oral cancer drugs, 72% of those using a specialty pharmacy were adherent, compared with 56% at retail pharmacies. Copay assistance cut the average initial copay for oral cancer drugs from about $1,226 to $125, and a coordinated model got patients to their first fill 5.7 days sooner. The report acknowledges that much of the research is observational and that more comparative studies are needed.
Specialty pharmacy is a fast-moving and concentrated part of the market. PBM-affiliated pharmacies dominate revenue, with the top three accounting for two-thirds of dispensing, while health systems are building their own specialty operations as 340B restrictions tighten. Those systems are watching federal changes such as CMS’ proposed 340B payment cut, which would reduce reimbursement to ASP minus 33.4%.
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