Specialty Pharmacy
Once narrowly defined as home infusion therapy drugs used to treat rare genetic diseases such as Gaucher’s or multiple sclerosis (MS), this $77 billion a year segment of the healthcare arena is now generally characterized by low volume/high dollars, chronic conditions, and complex care issues that must be managed to ensure a positive outcome. Covering both injectable and infusion therapies, drug costs are high ($6,000 or more per patient per year) and often require specialized delivery and administration on an ongoing basis to treat such major conditions as rheumatoid arthritis, Crohn’s, Hepatitis C, and allergic asthma.
These are drugs that often require more complex administration and care, with total costs of therapy reaching as high as $350,000 per patient per year. The combination drug/device therapies included in this category typically require intense clinical and administrative oversight to ensure proper administration for a chronic condition: hemophilia, infertility, various autoimmune disorders, and any number of different types of cancer. In addition to the drug itself (e.g., injectables, infusion, and some oral meds), medical supplies, home medical equipment, nursing care, and affiliated healthcare services delivered outside a hospital environment or physician’s office can include whatever is required to ensure full compliance with the prescribed therapy—from an IV pump and sterile gauze to daily home nursing visits to assist the patient in administering the drug. Services related to high-touch drugs can often add an additional 25% over-and-above the cost of the drug—sometimes as much as $75 per day of therapy (vs. 2% of the drug amount of traditional retail pharmacy).