What’s so special about specialty pharmacy?

For the past couple of years, I have repeatedly asked myself this question and my investigations over that time have informed my current thinking. I’ve concluded there isn’t much that is so “special” about these medications, or specialty pharmacy’s practices with them, that should require a unique channel outside of community pharmacy. There isn’t even a specific industry definition of specialty drugs that I’m aware of. It seems widely accepted that to be lumped into this category, therapies include high-cost drugs (greater than $10,000 per year), medications requiring patient education/training and ongoing therapeutic drug monitoring, and medications that may require special handing within their distribution.

By this way of thinking, I put to you the Covid-19 mRNA vaccine was a “specialty drug,” yet community pharmacy embraced the challenge and acted magnificently. Last week I read that community pharmacists have provided over 17 million Covid-19 vaccinations across Canada. So, why would I lump the Covid-19 vaccine into the specialty bucket?

• Would anyone disagree that in February 2021 the Pfizer mRNA vaccine was as precious as gold? There was very limited supply, huge demand and every dose was being accounted for. That seems like it qualifies as high-cost.
• I can’t easily think of another product that required the special type of handling that this vaccine demanded at its introduction.
• Practitioners were asked to reconstitute the product, educate and follow up with their patients and were trained to diligently track and report any adverse events.

Back in February 2021, two of my Sandstone Pharmacies locations were asked by Alberta Health to participate in the first wave of Covid-19 vaccinations being offered via community pharmacy, employing the “new” Pfizer mRNA vaccine. At that time, there was a huge demand for the vaccine, but little supply. The product required ultra-frozen temperatures during storage, and I kid you not, one of the specific reasons rural Alberta pharmacies were not chosen to participate was that Alberta Health determined that the Pfizer vaccine would jiggle too much on the delivery trucks going outside Edmonton, Calgary or Red Deer. Looking back at the billions of government dollars spent, I’m now trying to figure out why we didn’t redirect some stimulus dollars toward resurfacing rural highways to reduce the “jiggling factor” of the vaccine.

The point I’m making is that community pharmacies across Canada demonstrated they were very proficient in getting shots into the arms of Canadians, even when it involved a complex molecule like the mRNA vaccine.

I’ve concluded that the complexity built into community pharmacy being able to procure and dispense biologics, biosimilars and many other “specialty” drugs to our patients is mostly complicated by design. Pharma, their patient support programs (PSPs) and some of the current specialty pharmacy players have created a system that is difficult to navigate, and the players don’t seem very motivated to disrupt the current model.

Yet, I maintain that a disruption to the current model is exactly what is needed right now. The introduction of biosimilars into the Canadian market may provide the opportunity for community pharmacy to participate, but the opportunity won’t just fall into our laps. We’ll have to work for it.

What made me begin this journey a couple of years ago was the realization that most novel drugs being introduced will fall into what is the traditional “specialty drugs” category. If community pharmacy is locked out, then it will be impossible for us to maintain continuity of care for our patients at the counter. Further, if we remain locked out, I don’t know how we will achieve financial stability going forward. Insurers want to pay less and less for dispensing activities.

I did my homework and decided to partner with a company looking to create a network of community pharmacies across the country interested in biologics/biosimilars and I started to prepare the Sandstone Pharmacies teams for the Alberta biosimilar initiative. When Neighbourly Pharmacy purchased Sandstone Pharmacies, they were very supportive of what I had done to date, and I was tasked to work with the other Alberta Neighbourly pharmacies to ensure they were similarly prepared for the biosimilar initiative. The Adalimumab switch in Alberta is scheduled for May 1^st. That means it’s crunch time right now.

In a future blog (after May 1^st), I’ll let you know how successful I’ve been with the switch. Perhaps there will be a few pearls I can share for those of you in a province that hasn’t switched yet. Ultimately, I’m determined to do everything I can to enable community pharmacists to break down the “specialty” barrier. After all, it takes more than just the drug to be special; I believe it is the community pharmacist-patient relationship that is also special.