Specialty pharmacy and the medication access dilemma

Affordability, access to care, and accountability are the cornerstones of contemporary, Affordable Care Act (ACA)-based healthcare. In this new paradigm, providers are assuming greater accountability for improving patient outcomes, reducing costs, and providing higher quality care through a team-based, integrated, and collaborative approach. These concepts are particularly relevant to specialty pharmacy, a rapidly expanding healthcare sector and massive contributor to drug expenditures in the United States. In this issue, Schumock et al.1 show that specialty medications are top contributors to the annual growth in drug expenditures, and Colgan and Beacher2 highlight the intensifying importance of specialty pharmacy to health systems. Under ACA expansion, millions of previously uninsured patients are seeking healthcare that may include specialty treatment. Major stakeholders involved in specialty drug management must balance financial health with achieving optimal therapeutic outcomes. Some beneficial strategies used to attain this balance are insurer- or pharmacy-based care management programs, which may incorporate adherence monitoring, skilled nursing services, health-system integration of specialty pharmacy services, and manufacturer-sponsored therapy-support services and financial assistance programs. Conversely, some frequently used strategies are contrary to healthcare notions of access and affordability and create significant barriers to patients’ gaining access to specialty medications. Two major barriers are high costs and restricted distribution.