Mischaracterization of Specialty Pharmacies: NASP Corrects the Record

The October 21 Wall Street Journal article “Drug Makers Respond to Concerns Over Specialty Pharmacy Use” and a similar report published recently in the New York Times mischaracterize specialty pharmacies. The fact that a company calls itself a specialty pharmacy does not make it so. Simply stated, charging high prices for medications does not define a specialty pharmacy.

A specialty pharmacy is a state-licensed pharmacy that solely or largely provides only medications for people with serious health conditions such as cancer, hepatitis, rheumatoid arthritis, HIV/AIDs, multiple sclerosis, organ transplantation, or bleeding disorders. In addition to being state-licensed and regulated, specialty pharmacies are often accredited by independent third parties such as URAC® or the Accreditation Commission for Health Care (ACHC).

Specialty pharmacies provide medications and related high touch health care services to seriously ill people who need complex medications, assistance in using these medications properly and not infrequently, assistance with reimbursement. Specialty medications have a complex profile, often requiring intensive patient management as well as special handling and administration assistance. Though some are taken orally, many of these medications need to be injected or infused, some in a doctor’s office or hospital. 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.

Many specialty medications present financial challenges to patients, so specialty pharmacies provide assistance in arranging for payment by private insurance, Medicare, or Medicaid. Also, private health insurance organizations often change conditions of coverage or add or remove medications from formularies or pharmacies from “in network” status. In addition, when necessary, specialty pharmacies help patients seek financial assistance from patient support organizations or programs operated for this purpose by pharmaceutical/biotechnology manufacturers.

Specialty pharmacies often work closely with pharmaceutical manufacturers. However, specialty pharmacies are not manufacturers and do not establish prices for medications. Rather, specialty pharmacies connect severely ill patients with the medications that are prescribed for their conditions, provide the special handling and patient care services that are required for these medications, and support patients who are facing reimbursement challenges for these highly needed but also frequently costly medications.

The National Association of Specialty Pharmacy (NASP) represents 71 companies in the specialty pharmacy industry, including 42 of the nation’s leading specialty pharmacies. Our members have spent many years and have made a considerable financial investment in developing the management, systems, processes, and clinical capabilities required to ensure that their seriously ill patients can obtain and properly use medications that are complex and often life-saving. We care deeply about the patients we serve. NASP welcomes the opportunity to explain specialty pharmacy further and to present examples and additional information about the vital role our members play in alleviating disease and improving patient health.