Many patients think of a pharmacist primarily as the healthcare professional who fills a prescription.
With specialty medications, the pharmacist’s role can be much broader.
Specialty therapies are often used for chronic, complex, or rare diseases. They may require:
- Detailed patient education
- Prior authorization
- Complex dosing
- Clinical monitoring
- Specialty handling
- Infusion support
- Side-effect management
- Ongoing adherence
- Financial-assistance coordination
The medication may also cost thousands of dollars and require treatment over months or years.
For these patients, specialty pharmacists can become an important member of the care team.
Research examining health-system specialty pharmacy models has found benefits involving medication access, adherence, persistence, affordability, quality of care, and patient and provider satisfaction, although the strength of evidence varies by disease and care model. (PubMed)
What Is a Specialty Pharmacist?
A specialty pharmacist works with medications used to treat complex or chronic diseases.
These may include therapies for:
- Neurologic conditions
- Immune disorders
- Autoimmune diseases
- Rare diseases
- Dermatologic conditions
- Gastrointestinal disorders
- Other complex illnesses
Specialty pharmacists often work closely with:
- Patients
- Physicians
- Nurses
- Insurance companies
- Manufacturer programs
- Specialty pharmacy staff
Their role frequently extends beyond dispensing the medication.
Helping Patients Understand Their Treatment
Complex medications can be intimidating.
Patients may want to know:
- What does this medication do?
- How is it administered?
- How often will I receive it?
- What side effects should I report?
- How should it be stored?
- What happens if I miss a dose?
Pharmacists can help translate complicated medication information into practical guidance patients can understand.
Better understanding can help patients feel more prepared to participate in their own care.
Improving Medication Adherence
A medication can only provide its intended benefit when patients are able to follow the prescribed treatment plan.
Specialty medication adherence can be affected by:
- Side effects
- Forgetfulness
- Cost
- Insurance problems
- Complex schedules
- Medication delivery
- Transportation
- Treatment fatigue
Research from Vanderbilt Specialty Pharmacy found that patient-tailored specialty pharmacy interventions significantly improved medication adherence compared with usual care. At 12 months, median proportion of days covered was 0.93 in the intervention group compared with 0.87 in usual care. (PubMed)
That illustrates an important point:
Sometimes the problem is not that a patient does not want treatment.
There may simply be a barrier that needs to be identified.
Identifying Why a Patient Is Missing Treatment
A specialty pharmacist may help determine whether a patient is struggling because of:
- Side effects
- Medication cost
- Insurance delays
- Forgetfulness
- Scheduling
- Confusion
- Difficulty obtaining refills
Once the barrier is understood, the care team may be able to address it.
For example:
A patient who forgets medication may need reminders.
A patient who cannot afford the copay may need financial-assistance research.
A patient experiencing side effects may need the pharmacist to communicate with the prescribing physician.
Monitoring for Side Effects
Specialty medications may have significant or medication-specific adverse effects.
Pharmacists can help patients understand:
- Expected reactions
- Symptoms to report
- When to contact the pharmacy
- When to call the physician
- When emergency evaluation may be appropriate
Research evaluating specialty pharmacist interventions in multiple sclerosis found that common interventions involved adherence, medication regimens, adverse drug reactions, and laboratory monitoring. (PubMed)
The pharmacist does not replace the prescribing physician.
Instead, the pharmacist provides an additional clinical layer focused specifically on medication therapy.
Supporting Appropriate Laboratory Monitoring
Certain specialty medications require laboratory monitoring.
Depending on the treatment, the physician may order:
- Blood counts
- Liver testing
- Kidney testing
- Immunoglobulin levels
- Other disease-specific tests
Specialty pharmacists may help identify when required monitoring is due and coordinate questions with the physician.
In the multiple-sclerosis specialty pharmacy study, laboratory-value issues represented a meaningful portion of pharmacist interventions. (PubMed)
Helping Patients Begin Treatment
One of the biggest challenges in specialty pharmacy is often starting the medication at all.
A prescription may be written, but treatment can still be delayed by:
- Prior authorization
- Insurance documentation
- Specialty pharmacy requirements
- High copays
- Medication availability
- Site-of-care rules
Specialty pharmacists and pharmacy access teams can help coordinate these issues with the physician and insurance company.
A review of health-system specialty pharmacy literature identified medication access, affordability, initiation, and maintenance as important functions of specialty pharmacy teams. (PubMed)
Helping With Prior Authorization
Specialty medications frequently require insurance approval.
The insurer may request:
- Diagnosis
- Clinical notes
- Previous treatments
- Test results
- Dose
- Frequency
- Medication history
Specialty pharmacy teams can help identify payer requirements and coordinate documentation with the prescribing office.
Helping Patients Understand Financial Options
Even when treatment is approved, specialty medication costs can be substantial.
Depending on eligibility, possible resources may include:
- Manufacturer copay assistance
- Manufacturer patient-assistance programs
- Independent foundations
- Other financial-support resources
The pharmacist and pharmacy team can help patients understand how medication access, insurance, and affordability interact.
Coordinating With Physicians
Specialty pharmacists frequently communicate with prescribing providers.
That communication may involve:
- Medication questions
- Side effects
- Treatment interruptions
- Dose clarification
- Laboratory monitoring
- Refill issues
- Insurance requirements
This creates an additional connection between the patient and the prescribing physician.
Supporting Continuity of Care
Specialty patients often receive treatment over long periods.
During that time, circumstances may change.
A patient may:
- Change insurance
- Change physicians
- Be hospitalized
- Develop new symptoms
- Need a new authorization
- Change medications
Specialty pharmacy teams can help coordinate these transitions.
Continuity matters because interruptions in specialty therapy may occur for reasons that have nothing to do with the patient’s willingness to remain on treatment.
Coordinating Medication Deliveries
Some specialty medications require:
- Refrigeration
- Temperature-controlled shipping
- Scheduled delivery
- Special handling
Pharmacists and specialty pharmacy teams help coordinate appropriate storage and delivery so patients receive medication when needed.
For infusion therapy, this coordination may also involve:
- Infusion supplies
- Pumps
- Nursing
- Treatment scheduling
Supporting Home Infusion Patients
Specialty pharmacists are particularly important in home infusion.
A home-infusion patient may have questions about:
- Medication delivery
- Storage
- Supplies
- Infusion timing
- Side effects
- Nursing
- Missed treatment
The specialty pharmacist provides a medication-focused resource within the larger infusion team.
Pharmacist Interventions and Patient Outcomes
Research does not suggest that every pharmacist interaction automatically improves every clinical outcome.
However, evidence supports meaningful benefits from pharmacist-led and specialty pharmacy interventions in several areas.
A systematic review of pharmacist-led ambulatory-care interventions found favorable effects on medication-related problems, adverse-event management, adherence, and patient satisfaction, although results varied across interventions and conditions. (PubMed)
A separate review of health-system specialty pharmacies reported evidence of improved adherence, persistence, clinical outcomes, affordability, service efficiency, and patient satisfaction, while also noting that more comparative research is needed. (PubMed)
That nuance is important.
Specialty pharmacists should be viewed as part of a coordinated care system rather than as a guarantee of a particular outcome.
A Practical Example
Imagine a patient receiving a specialty medication every four weeks.
During a follow-up call, the patient tells the pharmacist that the last treatment caused significant nausea.
Instead of simply shipping the next dose, the pharmacist can:
- Document the patient’s symptoms.
- Review the medication and treatment history.
- Determine whether the physician should be contacted.
- Communicate relevant information to the care team.
- Reinforce physician-directed instructions.
That additional clinical attention can help identify problems before the next treatment.
Frequently Asked Questions About Specialty Pharmacists
Is a specialty pharmacist different from a regular pharmacist?
Both are licensed pharmacists. Specialty pharmacists focus heavily on complex specialty therapies and the clinical, operational, and access issues surrounding them.
Can a pharmacist change my medication?
Medication changes require appropriate prescriber involvement and authorization. Pharmacists may identify concerns and communicate recommendations to the prescribing physician.
Can specialty pharmacists help with insurance?
Specialty pharmacy teams often coordinate benefits verification and prior authorization alongside clinical staff.
Can pharmacists help with side effects?
Pharmacists can provide medication education, assess medication-related concerns within their scope, and communicate with the prescribing physician when appropriate.
Do pharmacists help with financial assistance?
Specialty pharmacy teams may help identify manufacturer or foundation assistance programs for eligible patients.
Are specialty pharmacists involved in home infusion?
Yes. Pharmacists play an important role in medication review, preparation, dispensing, patient education, and ongoing support.
Specialty Pharmacy Care Is About More Than the Medication
For patients receiving complex therapy, medication access is only one piece of successful treatment.
Specialty pharmacists can help patients:
- Understand therapy
- Stay on schedule
- Identify barriers
- Monitor medication-related concerns
- Coordinate with physicians
- Navigate access issues
At Mercy Pharmacy Group, pharmacists work alongside patients, physicians, nurses, insurance specialists, and other members of the care team to support coordinated specialty treatment.
About the Author
April Cable is the Senior Director of Operations at Mercy Infusion, with more than 35 years of experience in specialty pharmacy billing, reimbursement, operations, and patient access. She works closely with pharmacists, patients, physicians, insurers, and clinical teams to help patients navigate specialty medication treatment.
Individual treatment outcomes vary. Specialty pharmacy services do not guarantee medication effectiveness, adherence, insurance coverage, or specific clinical outcomes.
