Thursday, April 17, 2014

Inside Specialty Drug Dispensing at Physician Practices

As I discuss in Chapter 8 of the 2013-14 Economic Report on Retail, Mail, and Specialty Pharmacies, the growth in oral oncology products is encouraging physicians to dispense these products from offices and clinics. These practice-affiliated pharmacies act as “closed door” pharmacies by dispensing only to the practice’s patients.

For an insider’s perspective, check out a great video interview (below) with Ray Bailey, PharmD, Pharmacy Director for Florida Cancer Specialists (FCS), one of the largest U.S. oncology/hematology practices.

FCS operates Rx to Go, a specialty pharmacy that acts a central fill service for FCS’s 81 locations. Rx to Go dispenses more than 3,000 prescriptions per month. Most are oral oncolytics. (Note that Dr. Bailey misspoke on the video and said "3,000 prescriptions per day.")

As this video illustrates, manufacturers developing a specialty channel strategy should consider practice-affiliated pharmacies. It also highlights why Express Scripts partnered with Raintree Oncology Services.

Click here if you can’t see the video.

P.S. Dr. Bailey tells me that he's a big Drug Channels fan. Cool!

P.S.2. Like me, Dr. Bailey will be at next month's Armada Specialty Pharmacy Summit. See you in Vegas! #ArmadaSRx14


  1. As these arrangements become more commonplace, the smart employers will start to put pressure on Health Plans to re-evaluate their provider contracts to try to understand what impact this will have on them--or if you contract directly, you are smart to keep an eye on this ( e.g,. how does this impact your ability to try and implement utilization management, which APCs or Revenue codes are being impacted, and how all these things fall out WRT comparing net-net incremental impact vs. what things would have cost had they run through specialty pharmacy.) Interestingly, in some cases--if you can do it/get it--a well structured ASP-based pricing methodology can result in lower net costs; however, I don't think you can throw that out as a blanket generalization. All in all, this tells me that employers need to make sure their contracting folks and the pharmacy health benefits strategy folks work together on this, and if you don't have the in-house expertise to parse the issues, you might want to find some good consultants...

  2. I am convinced that, like muscles, there are slow and fast twitch neuronal networks (or maybe I'm the only one that has the slow ones). A question popped into my head today about this post, just today. So I understand that the Rx to go is considered a specialty pharmacy, but they are also a part of FCS... so what class of trade are they considered by wholesalers/distributors?... and.... is there some arbitrage that can be taken advantage of here?