Fertility treatments are not just emotionally taxing; they can be financially draining. Patients can choose from many local and national specialty pharmacies for their fertility drugs. This guide will summarize the programs and services that every patient and reproductive center should look for in a specialty pharmacy.
What is a Specialty Pharmacy?
Fertility treatments are not just emotionally taxing; they can be financially draining. Patients can choose from many local and national specialty pharmacies for their fertility drugs. This guide will summarize the programs and services that every patient and reproductive center should look for in a specialty pharmacy.
Why Does a Specialty Pharmacy Matter?
A specialty pharmacy is a pharmacy exclusively dedicated to providing medications that require special storage, handling, or specialized knowledge of the condition being treated. These medications are usually high-cost, complex, and are not immediately available at regular retail pharmacies. (Resolve, 2013) Commonly prescribed fertility medications are expensive and are often injected. In addition, reproductive specialists may prescribe a dosage that is customized for each patient. These are compounded specialty medications that are traditionally prepared only by specialty pharmacies.
1. Accreditation: Proven QualityMany specialty pharmacies profess to have the lowest prices, have the highest quality products, and have the most comprehensive and accessible patient education and support. But what services should a specialty pharmacy offer that save patients out-of-pocket expenses? How do patients have confidence in the quality of their fertility medications? Lastly, what educational programs should be available to assure that patients take or inject their medications correctly? Patients and reproductive centers should research their options and choose the specialty pharmacy that offers the most comprehensive selection of services.
Some specialty pharmacies invite outside accrediting agencies to inspect and test their products and to review their policies and procedures. These independent agencies have set very aggressive standards or benchmarks that a company must meet for their products or services to receive the agency’s accreditation.
Pharmacy Compounding Accreditation Board® Accreditation
Compounding, the expert creation of a personalized drug, is required when a patient’s prescribed dosage is not manufactured by a pharmaceutical company. A compounding pharmacist combines the appropriate ingredients, often under sterile conditions, to create a drug that is patient specific. The Pharmacy Compounding Accreditation Board (PCAB) is the nation’s recognized accrediting agency for compounding pharmacies. Compounding pharmacies voluntarily invest substantial time and money to prepare for and maintain PCAB accreditation, the gold standard for compounding pharmacies.
Utilization Review Accreditation Commission (URAC) Specialty Pharmacy Accreditation
URAC is the national leader in promoting quality health care with over 20 different accreditation programs across the continuum of care. URAC offers the only third-party, voluntary accreditation program of this scope for the prescription services industry. URAC standards were developed by stakeholders including: employers, consumers, pharmacy consultants, health plans, retail pharmacy, pharmacy benefit management organizations, pharmacy professional organizations; labor, and large public purchasing groups.
URAC accreditation is a critical seal of approval that gives increased certainty and consumer confidence.
2. Clinical Expertise and Experience
Specialty pharmacies should have one business – specialty pharmacy. Specialty pharmacy should not be an add-on service; it should be their only business. An indication of a specialty pharmacy that is committed to its fertility patients is the availability of pharmacists who have advanced training in fertility medications and treatments. A specialty pharmacy’s capabilities and procedures for third-party reproduction are another clear indication of the specialty pharmacy’s commitment and experience in fertility treatments and fertility medications.
Patients should also research a specialty pharmacy’s experience in fertility medications. A year or two or 10+ years? The unique needs of patients undergoing fertility treatments should not be left to a pharmacy that is new to the field. The consequences are simply too grave.
3. Cost Saving Programs and Services
a. Competitive and Transparent Pricing
Many specialty pharmacies publish prices for fertility medications. The prices may appear to be the lowest. However, there are often hidden costs that misrepresent the actual cost to the patient. Be sure to look beyond an online price list or quoted price by telephone.
b. Financial Assistance/Copay Assistance for Patients
Many pharmaceutical manufacturers offer copay assistance and/or financial assistance programs for the cash-paying patient to ensure that high out-of-pocket costs do not prohibit patients from accessing treatment. Patients are often unaware of these resources and are frequently overwhelmed by the applications and enrollment processes. A specialty pharmacy should routinely inform patients of financial assistance programs, initiate the process, and help patients to complete applications.
c. Prescription and Medical Billing
Insurance plans may cover fertility medications under a patient’s prescription benefit or medical benefit or both, depending on the drug and/or treatment. A specialty pharmacy must have the capability and staffing to research each patient’s insurance coverage. Many patients are unaware of the potential coverage available to them and using an inexperienced specialty pharmacy may result in unnecessary out-of-pocket costs.
4. Patient Education
A critical component to the success of fertility treatments is the proper administration of these highly technologically advanced injectable medications. For many patients, self-injection is a new and anxious experience. Patients may need to learn about sterile technique, reconstituting a powder, pre-loading a cartridge, priming a cartridge, drawing up the correct dosage into a syringe, and preparing the injection site. The specialty pharmacy should have clinical educators to go through the entire process in advance and to be available anytime to answer questions and concerns during treatment. Patients can benefit greatly from video training offered by specialty pharmacies. Being able to watch the proper preparation of an injection and the subsequent injection is an invaluable tool.
Specialty pharmacists should also counsel patients before the initiation of therapy, reinforcing and complementing the information received from their reproductive specialists.
5. Customer Service
Patients undergoing fertility treatments face challenges that are unimaginable to individuals taking traditional drugs. Every patient deserves the highest possible level of personal customer service.
a. 24/7 Clinical Support
Patients’ access to clinical pharmacists and nurses during their fertility treatments serves to improve adherence and the correct administration of fertility medications. A clinical specialist should be readily available from your chosen specialty pharmacy to answer questions and to assist patients with self-injections.
b. Specialty-trained Call Center Staff
Patients undergoing fertility treatments are prescribed medications that are unique to their situation. Many fertility medications have distinctive characteristics, such as requiring refrigeration or being injectable drugs. Specialty pharmacy call center staff must have knowledge about fertility medications and have the expertise to correctly respond to and resolve patients’ questions. Ideally, patients will have a designated specialty pharmacy call center staff member assigned to them for the duration of their treatment.
c. Regional Account Management
Account managers are a specialty pharmacy’s field-based facilitators. Account managers regularly visit fertility practices and meet with reproductive specialists, nurses, and management staff to update everyone on new drugs to the market, offer educational opportunities for staff and/or patients and to learn about the practice’s and/or patients’ challenges.
To read more, download our full fertility guide:
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