ST. LOUIS — Schnuck Markets Pharmacy recently advanced its three-year-old specialty pharmacy division with a new protocol for HIV that it helped develop with Therigy, a provider of Web-based specialty therapy management applications.
In doing so, Schnucks demonstrates how a regional chain can compete with major drug and large retail chains in the complex world of specialty pharmaceuticals.
Managing drugs for HIV patients presents particular challenges in comparison with other better-known chronic diseases because of the nature of the disease, which often requires multiple drug use over a long period of time. The disease also affects a disproportion of the population that has fewer financial resources and is less educated. Therefore, HIV patients require more assistance and management supervision of their drugs as well as case management of drug reimbursements.
According to the latest statistics from the U.S. Centers for Disease Control and Prevention, just over 682,000 people are living with a diagnosis of HIV infection in 40 states and five U.S. dependent areas. However, it is believed the figure is closer to more than 1 million due to the difficulty in compiling accurate figures on HIV.
In 2009, there were an estimated 42,959 new diagnoses of HIV infection and African Americans, made up an estimated 50% of new cases.
Dave Chism, Schnucks' supervisor of Specialty Pharmacy/PBM Services, who has expertise in HIV, came from a St. Louis hospital organization to help Schnucks launch its specialty pharmacy. He also brought other pharmacy clinicians from the hospital team to join the retailer.
Schnucks has four satellite specialty pharmacies, two in medical offices, dedicated to HIV care and other chronic diseases. The retailer is working in partnership with a local nonprofit group, Food Outreach, to provide specialty pharmacy services. The nonprofit provides food and nutrition services to about 1,700 HIV and cancer patients.
“We've worked with Therigy to design clinical programs that will enable us to more closely monitor our chronically ill cancer and HIV patients. Tracking their medication, diet and overall progress, we are able to partner with physicians to deliver a higher level of care and provide for better patient outcomes,” said Mike Juergensmeyer, Schnucks' vice president of pharmacy, in a press statement.
A new centralized processing facility enables Schnucks to fulfill specialty pharmacy orders as well as orders from its 101 in-store pharmacies and mail orders for its pharmacy benefit management service, enabling what's referred to as a “closed door specialty pharmacy” operation.
Therigy's HIV protocol covers over 60 medications.
Russel Allinson, chief executive officer and chief clinical officer of Therigy, Orlando, Fla., said he believes their protocol for HIV drug management that focuses on the therapy may be the first of its kind. It allows over time for the pharmacist to fine tune the therapy for maximum benefit and minimum side effects as well as compile valuable data.
Therigy has 12 disease-state Web applications that help manage patients and track their drug utilization. Pharmacists who subscribe to the service, which costs roughly $100 per user per month, have more time to concentrate on patient care. It also provides valuable data on management of the diseases that could be sold to manufacturers.
While managing specialty pharmacy requires investment and a different methodology, the margins remain as thin as traditional drug dispensing but the dollar volume base is high. Most specialty drugs cost well over $1,000 per month, and co-pays are higher. Third-party payment for specialty services are almost nonexistent at the moment, according to Therigy.
The reason many of the big retail players are investing in specialty pharmacy is because it's viewed as the only growth area in pharmacy. It is expected to grow even faster with an aging population.
Allinson told SN it is the “sweet spot” in pharmacy. “Growth in biotech for prescriptions and dollars is five times what the growth is in the traditional market,” he said.