The Challenges of Chemotherapeutic Specialty Drugs

by Don Jewler, Director of Communications, ACCC

REPORT FROM ACCC’S ONCOLOGY PHARMACY EDUCATION NETWORK PRE-CONFERENCE IN SEATTLE

“What is the definition of a specialty drug,” asked Michael L. Brandt, BS, PharmD, pharmacy clinical supervisor at Kootenai Medical Center in Coeur d’Alene, Idaho. “I will paraphrase a very famous line from the Supreme Court: No one can define a specialty drug, but you sure know it when you see it.”

Specialty drugs require special handling, administration, or monitoring and are used to treat complex, chronic, and often costly conditions, Brandt continued, going beyond his initial description. And generally specialty drugs are extremely costly.

One specialty drug for renal cell cancer, for example, under a new fourth payment tier of 33 percent co-pay comes to $7,000 per month or $84,000 per year. “People cannot get treatment if their co-pay if $7,000 a month,” said Brandt.

Two years ago ACCC noted the trend in the utilization of specialty pharmacy by payers in the oncology arena. Physicians used to make the decisions and negotiated contracts about which drugs and regimens can be used. Increasingly, specialty pharmacy distributors are making those decisions as pre-determination programs gain momentum in managing costs.

Today, during the opening session of ACCC’s Oncology Pharmacy Education Network (OPEN) Pre-conference, Dr. Brandt explored the new challenges of dispensing specialty drugs, including cost, reimbursement, and lack of access.

For a lot of these specialty drugs, says Brandt, patients have no choice as to where they can get their prescription filled. “You can get it from our specialty pharmacy, says the insurers, or you can pay full price. That’s not much of a choice.”

Patients are further challenged by having to go to the retail pharmacy for one drug, the specialty pharmacy of their cancer center for another, and the specialty pharmacy of their insurer for a third. Add to this, a complex therapeutic regimen, and compliance becomes extremely difficult.

What can be done to help the patients?

“Advocate for our patients. We need to be the voice of our patients. We need to say: I can walk you over to the person who can help you. I will find for you the best route. That is our job to help the person navigate through this system.”

That healthcare system of complex access and high out-of-pocket costs for chemotherapeutic specialty drugs is “broken,” says Brandt. That said, the advice he gives is to advocate and educate yourself, your administrators, your patients, and the providers.