In 2026, the specialty pharmaceutical industry is expected to hit $568 billion, with 9 out of 10 best-selling drugs by revenue being specialty medications. You may ask yourself, “What is a specialty medication and why is it so special?” According to the Pharmaceutical Care Management Association (PCMA), specialty drugs fall into the following categories that touch on cost and complexity:
- Prescribed for a person with a complex or chronic medical condition
- May not be stocked at retail pharmacies
- Have a high monthly and yearly cost for payers and patient’s out of pocket copays
- Have unique storage/shipping requirements
- Require additional patient education, adherence, and support
Patients who battle chronic diseases such as Rheumatoid Arthritis, HIV, or Crohn’s Disease may be prescribed specialty medications to treat their disease once conventional therapy has failed. These drugs often are not first-line therapies and are covered by insurance only if the patient meets clinical criteria established by the payor, usually resulting in patients having high copays and out-of-pocket costs with the risk of abandoning their treatment.
Millions of people are in need of specialty care and treatment. Therefore, almost all large chain pharmacies, biologic manufacturers, and Pharmacy Benefit Managers offer some sort of specialty service that results in patients choosing the chain or specialty pharmacy instead of their local community pharmacy. When a specialty script is transferred to a large chain pharmacy, it is likely that eventually the patient’s non-specialty medications get transferred as well. This decision creates a domino effect for independent pharmacies as they lose patients to a competitor, all because one “specialty” script could not be filled by the independent pharmacy.
Patients experience 3 barriers with specialty medications and specialty pharmacies:
- Access to specialty medication
- Affordability for both the pharmacy and patient
- Adherence to the specialty medication once started
Pharmacies struggle with gaining access to specialty medication due to payor or manufacturer restrictions. Whether the medication is a limited distribution to a few selected specialty pharmacies or the medication is not on the payor formulary, access to specialty medications continues to be a burden on independent pharmacies moving into the specialty market.
Specialty medications run at a high cost making it difficult for the pharmacy and the patient to afford them. With the average monthly co-pay being high, patients struggle to afford the medication that can control their chronic condition. However, independent pharmacies are experiencing low reimbursement fees per specialty prescription filled. This results in an unsustainable market for both the patient and the pharmacy.
Specialty medications are drugs that require a pharmacist to provide hands-on counseling and monitoring to treat the patient effectively. Adherence to specialty medications continues to be a patient burden when the medication is finally trialed. Independent pharmacies can provide one-on-one, hands-on patient counseling whereas some mail-order chain pharmacies are incapable of providing this service in person. Patient counseling has been shown to improve clinical outcomes and increase adherence to specialty medications.
At Outcomes, we provide solutions for independent pharmacies to manage and keep their specialty patients by overcoming the three barriers to specialty medication.
- Our Specialty Pharmacy Support Center allows pharmacies to rely on our team’s expertise to help navigate the process of filling specialty prescriptions, providing clinical tools, and following up with patients at the right time.
- Independent pharmacies can retain their patients and provide valuable specialty pharmacy services for their community.
- Our Hub Services help providers identify different ways to lower high out-of-pocket costs for their patients.
