At AllianceRx Walgreens Pharmacy, each covered entity we meet with describes circumstances unique to its hospital, patients, and pharmacy arrangements. The common element for all is the increasing complexity of 340B programming – often changing by the day. Other themes we often hear about include variable patient volumes, unpredictable cost trends and operational challenges.
These themes magnify when treating patients with complex and rare conditions as diagnosis-to-treatment timelines lengthen and treatment costs typically increase. To effectively serve these patients, specialty medications are a critical component of maximizing 340B program value.
Specialty Medications and Limited Distribution Drugs
Specialty medications are high-touch, high-cost therapies that treat rare and complex conditions. At AllianceRx Walgreens Pharmacy, we partner with biopharma manufacturers to solve the wide range of challenges often inherent to these therapies. Many of these products must adhere to intricate storage, temperature, and special handling requirements, and can be expensive. In order for specialty medications to be effective, it is essential these patients receive additional levels of clinical oversight and can access guidance from pharmacists trained on their conditions.
The specialty subcategory of limited distribution drugs (LDDs) are medications considered very high touch, have special requirements, and with relatively small patient populations. By limiting distribution of the drug to only a few pharmacies, manufacturers can ensure safe and timely distribution and a more consistent patient experience from the specialty pharmacy.1
Why Specialty Access Matters In 340B
Imagine a patient’s or caregiver’s relief upon getting a clear diagnosis for an unnamed medical condition they’ve battled for years. But feelings of frustration arrive when finding out the best treatment is a medication that’s too costly, or even unavailable through their hospital. Making specialty medications and LDDs available through your 340B program enables greater value by serving a core tenet – to deliver medically necessary health care services, medications, and pharmacy support services for free or at reduced cost to qualifying patients.
While specialty medications accounted for almost 50% of drug spend in 20202 the average cost of a specialty drug is $4,500 per month.3 Even if cost were no object, accessibility continues to be a key element. According to the 2019 State of Specialty Pharmacy Report, nearly 85% of manufacturers manage some or all products through a limited distribution mode.4
What Covered Entities Should Look For:
Finding the right specialty pharmacy partner can go a long way to support patient access and minimize impact on current pharmacy operations at your hospital.
To maximize 340B program value with specialty medications, it’s critical to evaluate:
1. How many LDDs the specialty pharmacy dispenses, and which ones. Are the LDDs available for the therapeutic areas and/or disease states most important to your prescribers?
2. How the specialty pharmacy helps assess a patient’s ability to afford a specialty medication.
3. How patients and caregivers are supported through managing a complex condition. What dedicated teams and virtual touchpoints are available to help navigate their treatment journey?
4. Whether or not pharmacists are available to guide patients through treatment and side effects. How are pharmacists trained and accessible to help patients overcome treatment barriers?
5. How the specialty pharmacy addresses medication non-adherence. What programs and tools are in place for refill reminders, identification of missed doses or adherence concerns?
6. How gaps are bridged between patient and prescriber. When and how do pharmacists communicate with prescribers about therapy or areas of concern?
Through the turbulent regulatory climate, we partner with covered entities to maximize their 340B program value so we can all achieve our aligned goals – delivering the care patients need for complex and rare conditions, when they need it; improving patient access to life-changing specialty medications; and supporting medication adherence and improved patient outcomes.
1 T. James, RPh, Four Things to Know About Limited Distribution Drugs, 5/5/2021.
2 Tichy EM, Hoffman JM, Suda KJ, et al. National trends in prescription drug expenditures and projections for 2021. Am J Health Syst Pharm. 2021, 7/9/2021.
4 2019 State of Specialty Pharmacy Report, CSI Group., accessed 7/13/2022. https://csigroup.net/
Robin George, CPHT, is Manager of Health Systems Platform Innovation at AllianceRx Walgreens Pharmacy. He can be reached at firstname.lastname@example.org.