August 2, 2021

Insights Into Shifting From Traditional Retail to Specialty Pharmacy

By David M. Suchanek, RPh
Published Online: Monday, Nov 27, 2017

As part of these capabilities, a core component for success is the IT software. Typically, most retail software solutions do not meet the requirements of the specialty marketplace. Core component differentiations include but are not limited to:

  • Physician office communication preferences
  • Clinical pathways that can vary by disease, product, or specific manufacturer
  • Enhanced billing data capture (primary, secondary, tertiary payer information, copay information, co-pay assistance information, etc)
  • Enhanced prior authorization data collection (some products may have a protocol that involves more than 30 steps before gaining prior authorization)
  • Ancillary educational support material dispensing (dispensing a brochure as though it were a drug: inventoried and reportable)
  • Refrigeration requirements
  • Enhanced patient assistance leaflets (disease, drug, manufacturer specific)
  • Ability to ship and track the order via courier or third-party carrier (FedEx, UPS)

Second, accreditation is typically required for a pharmacy. Most payers, PBMs, and manufacturers are using accreditation as the primary condition for participation in a network or access to product. This means that if you are not accredited, you very likely will not be considered for participation in a network. URAC, ACHC, the Joint Commission, CPPA, and NABP all have accreditation offerings and standards that may be required. These accreditations are an investment in specialty pharmacy but may take a few years to fully implement. Frequently, enhanced telephony, clinical assessments, standard operating procedures, and quality programs are required for accreditation, and the pharmacy must maintain these standards over time. The programs require an application fee and ongoing internal maintenance costs, while some may include reporting measurement and clinical information to a third party, which carries an additional cost.

Next, as with all businesses, specialty pharmacies must attract and retain customers. Given the current competitive environment, many pharmacies in the specialty space are turning to dedicated sales teams to help drive prescription growth. Capturing specialty prescriptions requires skilled sales representatives collaborating closely with their customers to earn business—most pharmacies lack the experience, time, and ability to hire, train, and manage a dedicated sales team. 

Consequently, many pharmacies do not even have a sales team—and even if they do, the “team” may simply be a former drug sales representative or even a pharmacy technician promoted into the role. The result is that the sales representatives lack the required background or are sent into the field with little or no training and limited accountability for their performance. Most of these reps are unsure of how to perform their job effectively and, as a result, ultimately fail in the field or produce lackluster results. This is frequently the result of one simple factor—the lack of effective sales training. To build relationships and win business, we have found that an effective specialty sales representative needs to fill multiple roles: salesperson, account manager, project manager, and consultant. This role may also require interaction with payers as well. Ultimately, these efforts require an investment by the specialty pharmacy.

Because of these challenges, we personally, and others, were drawn to provide “special” solutions for the marketplace. What we chose to do was new and took us out of our comfort zone to provide what our patients needed. As our current health care system continues to change, it is important for pharmacists to do what some peers will not venture to do: evolve.

Specialty has been and continues to be about bringing solutions to stakeholders and linking them cohesively (Figure). It started simply with providing services to physician offices, manufacturers, payers, and patients. 

It has now evolved to include REMS programs, 501(c)(3) foundations, hospitals, home health/nursing services, infusion suites, wholesale, and hub services.  

Soon, we expect to see integrated lab and genomic testing, media tool–driven adherence support services, and Web portals that empower patients to co-manage their disease with their health care team in a real-time environment. We all need to continue evolving. Many pharmacies have invested and had a very positive return on their investments. There is a tremendous amount of opportunity if pharmacies take the proper time to thoroughly educate themselves on the specialty marketplace, develop a business plan, vet the plan with those who have traveled the path before, and execute and invest fully. Consider using an experienced consulting group to assist you in this critical journey. A modest investment pays dividends. Check out the consulting groups’ pedigree and references. Not only can they get you there faster, but more important, they can provide you with the tools and experience to get you there correctly the first time. 

About the Author
David M. Suchanek, RPh, is executive vice president of biotech and specialty services at D2 Consulting.


About the Specialty Pharmacy Times Industry Guide

The Specialty Pharmacy Times Industry Guide includes comprehensive editorial content relative to all specialty pharmacy stakeholders. Content includes information relative to market trends, commercialization, distribution, order to cash, HUB Services, managed care strategies and DIR fees. The guide also includes profiles, and a complete list of stakeholders along the patient journey: specialty pharmacies, wholesaler distributors, manufacturers, support services, group purchasing, and trade associations.

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