Specialty Drugs in the US Healthcare: Unlocking Opportunities for PBMs and Pharmacy Owners

The US healthcare industry has witnessed rapid growth over the recent years in the specialty drugs sector.

These medicines are designed to treat complex and chronic health conditions like cancer, rheumatoid arthritis, hepatitis C, etc.

As specialty drugs have significantly improved patient outcomes, it has presented opportunities for various domains in the healthcare system.

The Role of Specialty Drugs in Healthcare

Specialty drugs are different from traditional medicines in different ways.

These medicines

• Are expensive
• Requires specialized handling & administration
• Involves complex reimbursement process
• Are not easily available

These medicines target a smaller patient population having specialized conditions and need customized patient support programs.

Specialty drug growth is fueled by advancements in the biotechnology field.

It enables more effective treatments for previously untreatable or hard-to-manage diseases.

The Impact of Specialty Drugs on the US Healthcare

Specialty drugs have opened doors of upgradation in several domains of the healthcare industry.

Along with that, it has impacted the industry in several ways.

● Enhanced Patient Outcomes

Specialty drugs have revolutionized the treatment landscape for patients with chronic and complex conditions. 

They offer: 

• Improved Symptom Management
• Disease control
• Extended survival rates

Impacting the lives of patients positively.

● Financial Implications

The high cost of specialty drugs poses financial challenges for patients, payers, and healthcare providers. 

However, they also present revenue-generating opportunities for PBMs and pharmacy owners, as they often provide higher profit margins compared to traditional medications.

● Evolving the Role of PBMs

PBMs play a crucial role in managing specialty medications. 

They offer various services

• Negotiating drug prices with manufacturers
• Implement utilization management strategies
• Administer patient support programs
• Develop formularies
• Facilitate the distribution of specialty drugs
• Manage complex reimbursement processes

● Expanding Pharmacy Services

Specialty drugs have prompted pharmacy owners to diversify their services and expertise. 

Pharmacies are now equipped to provide comprehensive patient counseling, administer specialized injections or infusions, and offer medication adherence programs. 

This expansion presents an opportunity for pharmacy owners to enhance their revenue streams and establish themselves as integral members of the healthcare team.

Leveraging Opportunities for PBMs and Pharmacy Owners

● Clinical and Financial Management

PBMs can create innovative programs to manage the clinical and financial aspects of specialty drugs. This includes:

• Developing comprehensive utilization management strategies
• Coordinating patient support services
• Implementing cost-containment measures (such as prior authorizations and step therapy protocols)

● Formulary Optimization

PBMs can optimize formularies by carefully selecting specialty drugs based on clinical efficacy, cost-effectiveness, and patient outcomes. 

Collaboration with healthcare providers and pharmaceutical manufacturers can facilitate access to the most beneficial therapies while ensuring optimal utilization of resources.

● Enhanced Patient Support

PBMs can offer comprehensive patient support programs, including medication counseling, adherence monitoring, and financial assistance. 

These services improve patient engagement, medication adherence, and overall treatment outcomes.

● Collaborative Networks

Pharmacy owners can establish partnerships with healthcare providers, PBMs, and specialty pharmacies to create collaborative networks. 

These types of networks 

• Enhance patient care coordination
• Facilitate timely medication access
• Enable efficient communication among stakeholders
• Improved patient outcomes and satisfaction

● Technology Integrations

PBMs and pharmacy owners can leverage technology solutions to 

• Streamline administrative processes
• Enhance medication tracking
• Facilitate real-time communication between healthcare providers, payers, and patients

Automation and data analytics can optimize inventory management, streamline billing and reimbursement processes, and identify trends in medication utilization.

A useful resource: Pharmacy Workflow Automation Solutions

Make the Most of these Opportunities with our Health Tech Solutions

Though the opportunities are appealing, it needs strong health tech knowledge and experience to build software for specialty drug pharmacies.

Ensure that the development company you choose has a record of working in the healthcare domain.

Understanding your compliance, tech, and business needs is one of the vital steps to building or upgrading your health tech.

If you want to build, upgrade, or integrate your pharmacy software for it to be used with specialty drugs then, you’re at the right place.

We’re an Ontario-based healthcare IT company.

We follow the 3Es in our approach - Experts, Experience, and Expertise.

Combining the hands-on experience of 8+ years with extensive knowledge of the regulations, we had successfully delivered 60+ projects.

If you have any health tech requirements for your pharmacy business, connect with us by filling out the form below.