$1B in health system savings: So why isn't there adequate funding for specialty medication services in pharmacies?

From dispensing and administering intravenously delivered drugs to investing in cold-chain technology, Canadian pharmacists contribute significantly to the care of patients taking specialty medications—ultimately saving the country’s healthcare system approximately $1 billion. Yet so much of the care wrapped around the dispensing of specialty drugs is unfunded by public healthcare, leaving pharmacists uncompensated for these extra—and necessary—services. “When we’re talking about specialty medications, it’s important for everybody to understand the value of the care pharmacists provide to these complex patients who are taking these types of therapy,” said Shelita Dattani, vice president, pharmacy affairs at Neighbourhood Pharmacy Association of Canada. “Whether it’s cold chain monitoring or reimbursement navigation or adherence monitoring, the contributions that pharmacy makes are critical to ensuring that these patients get good care and outcomes.” A recent study by Neighbourhood Pharmacy—developed in partnership with health data analytics firm IVQIA Canada—looked at the 47,000-plus pharmacists in about 11,550 pharmacies which dispense more than 13 million specialty prescriptions each year to 1.9 million patients. The study’s conclusion? In the face of rising costs and markups for many specialty drugs, the efforts of these pharmacists make a big difference to the patients who take often-complex medications, and to the taxpayers that fund Canada’s health system. “Pharmacies safeguard the distribution and preserve the integrity of $13 billion worth of specialty drugs every year,” the study authors wrote in a report called The Value of Specialty Pharmacy Services to the Healthcare System. “This figure continues to grow at an approximate rate of 10% annually.” Specialty-service pharmacies also contribute millions of hours in clinical services each year, filling in gaps in services that might otherwise need to be delivered by doctors and nurses. For instance, pharmacists provide an estimated 8.9 million hours of clinical medication management services each year, which the report from Neighbourhood Pharmacy estimates would cost $790 million if these same services were provided by physicians. Read: Embracing change: Specialty pharmacy in Saskatoon Despite the value they bring, and in the face of increasing numbers of patients requiring specialty medications, specialty-services pharmacists continue to be compensated based on the products they dispense and not for the enhanced services they provide, said Dattani. “There’s nothing paid for things like follow-up or reimbursement navigation,” she said. “The funding is tied to the product.” Even when products come down in cost—as was the case recently with biosimilars—pharmacies must still provide the same level of services and, in many cases, provide additional new services. “Patients switching from a familiar biologic to an unfamiliar biosimilar require additional transition assistance from their pharmacy team,” wrote the study authors. “These biosimilar-specific services aim to ensure that patients are comfortable with the new medication and understand its benefits, potential side effects and dosing requirements. They also typically involve counselling from trained pharmacists in response to patients’ specific questions or concerns, which can prove vital for medication adherence and treatment outcomes.” Yet biosimilars generate less funding for pharmacies because of smaller markups from their lower price points. “This discrepancy puts the sustainability of specialty services at risk, which in turn threatens patient care and therapeutic outcomes,” added the authors. “While some provinces have implemented a small one-time fee for pharmacies to support patients transitioning to biosimilars, it compensates but a fraction of the time required to support patients in their transition to a biosimilar.” Without the enhanced services of pharmacies that dispense specialty medications, patients could find it harder to get the medications they need and would face increased out-of-pocket costs and reduced access to professional advice. Read: When a pharmacist comes to your rescue “The negative impact on patients’ health and well-being could be devastating,” wrote the authors. “Their risk of adverse drug events, interrupted therapy and poorer health outcomes would be higher.” The report noted the “substantial costs” for pharmacies to provide specialty services. Those that have chosen to dispense only specialty medications have collectively invested nearly $700 million upfront to build facilities with the right infrastructure, with each facility costing upwards of $10 million. These specialty pharmacies also face approximately $1.2 million each year in ongoing expenses and spend between $100 million to $200 million, in aggregate, each year to maintain their facilities and equipment. These investments are necessary because of the particular handling and storage requirements for specialty medications. In Canada, more than 40% of the 13 million specialty medications dispensed annually require cold-chain protection, which costs between $400,000 and $2 million per pharmacy per year, according to the report. Money isn’t the only contribution pharmacists make towards caring for patients on specialty medication, which are a growing part of the pharmaceutical landscape in Canada. According to the report, pharmacists put in about 8.9 million hours of clinical services each year to help ensure these patients get the best outcomes. Pharmacists also play the critical role of payment reimbursement navigators. Specialty medications can cost $10,000 on average per year and some can run up to $100,000 annually. Getting public insurance coverage is often a complex process—for instance, 70% of non-oncology drugs approved from 2010 to 2020 needed special authorization in at least one Canadian province—and many patients don’t know they’re eligible for coverage. “Reimbursement navigation support is essential, and a key offering of Canadian pharmacies that provide specialty services,” wrote the study authors. Read: Ontario proposes letting pharmacists prescribe flu meds, give RSV vaccines A number of Canadian studies have found oncology patients who had access to reimbursement navigation services started their drug therapy six to 25 days sooner—a significant difference because a one-month delay in cancer treatment can increase the risk of death by 13%, according to the Neighbourhood Pharmacy report. Reimbursement and care navigation services have also been found to help improve medication adherence by 83%. “In addition, patients who received support from navigators were 69% less likely to stop treatment and 20% more likely to be in remission compared to those who did not,” wrote the authors. The report also highlighted pharmacy’s role in administering specialty medications by intravenous infusion—98% of all specialty infusion clinics in the country are managed or operated by pharmacists—and providing the compounding services that are required in an estimated 10% to 20% of all specialty medications. While specialty medications represent just a tiny fraction—a mere 1.7%—of medications dispensed in Canada, they account for 44% of the total dollar value. But as more specialty medications become available, their use is also likely to increase, said Dattani. “More and more, the number of patients who require these types of medications are going to increase because newer therapy for complex diseases continue to come out every year,” she said. “But the services are currently not funded by the healthcare system. So we just need to understand how much (pharmacists) can contribute in value.” Read: Minor ailments a conflict of interest for pharmacists? Pu-leeze!

$1B in health system savings: So why isn't there adequate funding for specialty medication services in pharmacies?

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