Oncology - How Specialty Pharmacy has Shifted the Care Landscape

Over the last decade there has been a large influx of new, oral, targeted therapies approved by the FDA to help manage disease in patients living with cancer. Oral targeted therapies are designed to work on specific targets on cancer cells, which often makes them more effective, and tolerated better than their IV counterparts. In addition, taking a pill every day allows a patient to enhance their quality of life by reduction of taking time out of their day to go to a clinic and receive an infusion.

The management of these therapies is often designated to a Specialty pharmacy. A specialty pharmacy is one that handles complicated disease states. It has trained clinical staff to help manage these specialty medications, including often serious adverse events, to help patients stay adherent to their therapy. These pharmacies will assist the patient through the process. They almost always require insurance Prior Authorizations. When approved, the average price of an oral oncology med can be $15,000/month. Even with good insurance, Medicare beneficiaries often face coinsurances of over $1,000/month. Numerous studies have confirmed that if a patient cannot afford the medication, they will not take it…this can lead to disease progression, hospitalizations and unfortunately death. 

A specialty pharmacy will work with the patient, their prescriber and the insurance to get the drug approved. Specialty pharmacies also have dedicated teams of financial assistance personnel who look for ways to offset these high financial burdens. They work with the patient to find a grant, a copay card or even working with the manufacturer to obtain the drug for free for eligible patients,

Some specialty pharmacies are integrated with clinics. This offers an extra advantage of having access to the patient’s medical record. This allows the pharmacy to have instant visibility to the physician notes, labs, pathology reports, etc. Having this information at their fingertips helps the pharmacy with getting drugs approved, evaluating appropriateness of therapy, intervening when appropriate, and reducing waste.

Specialty pharmacies working closely with patients and providing them with these oral targeted therapies significantly can help patients increase their quality of life and can increase progression free as well as overall survival. As new therapies emerge, they continue to provide patients with more options that may not have existed a few years ago. Managing these complex therapies takes a team of dedicated, experienced specialists, from the Oncologists to the Specialty Pharmacy team.