What's So Special About Specialty Pharmacy. Specialty Pharmacy Explained.

What's So Special About Specialty Pharmacy. Specialty Pharmacy Explained.

Specialty Pharmacies dispense prescription medications that require 'high touch' 1) distribution, 2) administration and 3) patient management.

Specialty Pharmacies began in the 1970s and even in the 1990s were very small with there being only about 30 different specialty medications.

Specialty Pharmacies make up only 3% of total pharmacies and are accredited by either the Accreditation Commission for Health Care (ACHC) or the Utilization Review Accreditation Commission (URAC).

The largest Specialty Pharmacies are owned by the three largest PBMs:
1) CVS Specialty Pharmacy... $73B in annual revenue
2) Accredo (specialty pharmacy of Express Scripts)... $60B in annual revenue
3) Optum Specialty... $32B in annual revenue
4) Walgreens Specialty Pharmacy... $8B in annual revenue
5) Walmart and Kroger Specialty Pharmacies... $3B in annual revenue each

The PBM-owned specialty pharmacies are so much bigger because the PBMs will only pay for specialty medications if they are filled at their own specialty pharmacy--limiting competition.

The Supreme Court gave states the right to regulate PBMs in 2020 and Oklahoma passed a law forbidding PBMs from only using their own specialty pharmacies. However, the PBMs sued Oklahoma and won in an Appeals Court.

Subsequently, 32 states have asked the Supreme Court to overrule the Appeals Court. The Supreme Court has yet to respond.

Sources:
www.pharmacytimes.com/view/reflecting-on-the-histo…

www.ncbi.nlm.nih.gov/pmc/articles/PMC2706163/

www.drugchannels.net/2024/04/the-top-15-specialty-…

www.achc.org/

www.urac.org/accreditation-cert/specialty-pharmacy…

www.mercer.com/en-us/about/newsroom/mercer-survey-…

ohiocapitaljournal.com/2021/11/05/cvs-sometimes-fo…

www.oklahoman.com/story/news/2024/08/13/oklahoma-d…

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