The characteristics of specialty pharmacies and traditional retail pharmacies fundamentally differ because each serves very specific patient populations with very specific needs. These differences are appreciated when one considers a patient’s contact with pharmacy staff at the time of their prescription fill or refill; the scope of services and support offered; the degree of communication between patient, pharmacy and physician; and the continuity of care offered by retail and specialty pharmacies. Watch this video to learn more about the role of specialty pharmacies.
Discover how contact and care play such a prevalent role in specialty pharmacy.
Contact: Drive-Through Versus Clinical Consultation
At a traditional retail pharmacy, patients often have the convenience of driving to a pick-up window to get their medication. A pharmacy technician collects their co-pay, asks them if they have any questions, and then hands patients their medication. Patients can also choose to go into the pharmacy and will go through the same process though there is a private room/space available for patients to speak with pharmacists.
Avella patients receiving a specialty medication receive an in-depth medication consultation. Avella pharmacists review the indication for the medication’s use, the proper way to take the medication (adherence), and potential side effects and ways to prevent or minimize them. Avella gives patients the opportunity to discuss their condition and specialty medication from the comfort of their homes. Learn more about Avella's role in patient care.
Care: Payment Focused Versus Patient Focused
If a patient cannot afford their medication, the retail pharmacy will not dispense the patient’s medication and typically will provide little support with co-pay assistance or offering alternatives. The patient is left to their own devices to figure out how to pay for their medication. This may lead to some patients never getting the medication they need.
If the patient’s insurance company requires a prior authorization, the retail pharmacy usually contacts the patient’s physician to complete the prior authorization process. The retail pharmacy tells the patient to contact their physician, and the patient leaves without their medication.
Patients receive support in securing financial help with their co-pays from Avella’s financial assistance specialists. These professionals have strong working relationships with several nonprofit organizations that offer financial assistance to patients with conditions that demand expensive specialty drugs. In addition to nonprofit resources, financial assistance team members are well-versed with manufacturer co-pay assistance programs. Avella secured $7,210,228 in financial assistance in 2012 for Avella patients, a 46% growth from 2011.
Many specialty medications require prior authorizations from patients’ insurance companies (payors). Headed by Avella’s Clinical Department, the prior authorization team works with the payor to provide clinical justification for the specialty medication prescribed. Avella takes the lead in the prior authorization process, relieving physicians and their staff of the time-consuming research and documentation. In 2013, prior authorizations managed by Avella averaged only 2.1 days’ turnaround time, a testament to the team’s expertise.
Watch for Part II of this blog series giving further insights into the differences between specialty pharmacies and traditional pharmacies next week.
We invite you to watch our informative video to explain how a specialty pharmacy differs from a traditional retail pharmacy. The 90-second video utilizes animation to describe the differences between specialty pharmacies and traditional retail pharmacies.
This article is also featured in our latest issue of, Dispensing Excellence, a publication devoted exclusively to specialty pharmacy patients and providers.
