Is Your Technology Up To Speed?

Exploring the potential of specialty services in retail pharmacy. Is your pharmacy equipped for the challenges of dispensing specialty medications?

The specialty pharmacy landscape is a complex ecosystem demanding precision, efficiency, and patient-centric care. From managing high-cost medications to navigating insurance requirements, pharmacies must have the right technological solutions to support them. Is your pharmacy equipped for the challenges of dispensing specialty medications?

A Complex Specialty Medication Onboarding Process

One of the biggest differences between specialty and more mainstream pharmacy dispensing, according to Chris Antypas, Pharm.D., founder and president of Perigon Pharmacy 360, near Pittsburgh, Pa., is that specialty pharmacies must take a proactive approach to patient management. “This is distinct from proactive refill management in traditional pharmacies,” says Antypas.

Chris Antypas, Pharm.D., Founder and President, Perigon Pharmacy 360

This is because specialty pharmacies face significant operational challenges during the patient onboarding process. In fact, according to Antypas, it’s more accurate to refer to a new specialty medication as a referral until it’s confirmed that the pharmacy can actually dispense it. This means that there’s a need for systems that can effectively track and manage the medication and the patient throughout a process, with numerous steps even before a referral becomes a prescription.

Managing Insurance

One important step with a new referral is the process of running insurance eligibility checks to determine what a patient’s insurance benefit is. “You need to have steps in your workflow that allow you to investigate details such as whether the specialty medication is covered under the pharmacy benefit or the medical benefit,” Antypas explains. “Then you need the ability to run test claims and confirm that you have the right information.”

Next, the vast majority of prescriptions a specialty pharmacy dispenses also require prior authorization, according to Antypas. This is something you’ll determine during the eligibility check. “When there are prior auth requirements,” says Antypas, “you need to research and document where to send the clinical information.”