Attachment 16 - NASP Definitions of Specialty Pharmacy and Specialty Medications.pdf

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R408--FY24 IVC PHARMACY BENEFIT MANAGER
Solicitation number
36C79123R0007
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This document defines specialty pharmacy and specialty medications. It was developed by the National Association of Specialty Pharmacy to represent the growing specialty pharmacy industry in the United States. The document defines a specialty pharmacy as a state-licensed pharmacy that provides medications for people with serious health conditions requiring complex therapies such as cancer, hepatitis C, and rheumatoid arthritis. Specialty pharmacies are accredited by independent third parties to ensure quality of care. They connect patients with specialty medications, provide required patient care services, and support patients facing reimbursement challenges. Specialty medications are used to treat patients with serious and life-threatening conditions and have a complex profile requiring intensive management. They may be oral but often must be injected or infused and have special handling and administration requirements. Patients on specialty medications require comprehensive care, clinical management, and product support services that typical retail pharmacies cannot provide.

The related federal contract opportunity is solicitation number 36C79123R0007 from the Department of Veterans Affairs for a pharmacy benefit manager for its Veterans Integrated Service Network 19.

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36C79123R0007 0003 9-25-23.docx DOCX document
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NATIONALASSOCIATIONOF
SPECIALTYPHARMACY

1800 Diagonal Road

Suite600
Alexandria,VA22314

www.naspnet.org

NASPDefinitionsofSpecialtyPharmacyandSpecialtyMedications
February24,2016
TheNationalAssociationofSpecialtyPharmacy
Thefollowingdefinitionsofspecialtypharmacyandspecialtymedicationsweredevelopedby
theNationalAssociationofSpecialtyPharmacy(NASP).NASPwasfoundedin2012torepresent
therapidlygrowingspecialtypharmacyindustryintheUnitedStates.Itisprojectedthat
specialtydrugswillrepresent50%oftheUSdrugspendbytheyear2019.Currently,NASPis
comprisedof84corporatemembersand1,500individualmembers,includingthenation’s
leadingindependentspecialtypharmacies,retailchainspecialtypharmacies,andhealth
system-basedspecialtypharmacies.NASPiscommittedtospecialtypharmacisteducationand
certificationandstronglyinvestedinthecontinuingimprovementofspecialtypharmacy
practiceasadvancesinmedicineandtreatmentregimensemerge.
WhatisaSpecialtyPharmacy?
Aspecialtypharmacyisastate-licensedpharmacythatsolelyorlargelyprovidesonly
medicationsforpeoplewithserioushealthconditionsrequiringcomplextherapies.These
includeconditionssuchascancer,hepatitisC,rheumatoidarthritis,HIV/AIDS,multiplesclerosis,
cysticfibrosis,organtransplantation,humangrowthhormonedeficiencies,andhemophiliaand
otherbleedingdisorders.Inadditiontobeingstate-licensedandregulated,specialty
pharmaciesshouldbeaccreditedbyindependentthirdpartiessuchasURAC®,the
AccreditationCommissionforHealthCare(ACHC),theCenterforPharmacyPractice
Accreditation(CPPA)ortheJointCommission,inordertoensureconsistentqualityofcare.
Specialtypharmaciesconnectpatientswhoareseverelyillwiththemedicationsthatare
prescribedfortheirconditions,providethepatientcareservicesthatarerequiredforthese
medications,andsupportpatientswhoarefacingreimbursementchallengesforthesehighly
neededbutalsofrequentlycostlymedications.
Specialtymedicationshaveacomplexprofilethatrequireintensivepatientmanagement.
Somespecialtymedicationsalsorequirespecialhandling.Thoughsomearetakenorally,many
ofthesemedicationsneedtobeinjectedorinfused,someinadoctor’sofficeorhospital.
Specialtypharmaciesprovideservicesthatincludetraininginhowtousethesemedications,

A t t a c h m e n t 1 6

NASP Definitions-February 24, 2016 2

comprehensivetreatmentassessment,patientmonitoring,andfrequentcommunicationwith
caregiversandthepatient’sphysicianorotherhealthcareproviders.
Theexpertservicesthatspecialtypharmaciesprovidedriveadherenceandpersistency,proper
managementofmedicationdosingandsideeffects,andensureappropriatemedicationuse.
Thespecialtypharmacy’spatient-centricmodelisdesignedtoprovideacomprehensiveand
coordinatedmodelofcareforpatientswithchronicillnessesandcomplexmedicalconditions,
achievesuperiorclinicalandeconomicoutcomes,andexpeditepatientaccesstocare.
WhatisaSpecialtyMedication?
Specialtydrugsaremorecomplexthanmostprescriptionmedicationsandareusedtotreat
patientswithseriousandoftenlifethreateningconditionsincludingcancer,hepatitisC,
rheumatoidarthritis,HIV/AIDS,multiplesclerosis,cysticfibrosis,organtransplantation,human
growthhormonedeficiencies,hemophiliaandotherbleedingdisorders.Thesemedicationsmay
betakenorallybutoftenmustbeinjectedorinfusedandmayhavespecialadministration,
storageanddeliveryrequirements.Manyoftheseinjectablemedicationsareself-administered
inthepatient’shome.Infusedspecialtymedicationsareadministeredinvarioustreatment
settingssuchasapatient’shomewiththesupportofahomehealthcareprofessional,
sometimesinadoctor’sofficeoreveninahospital.
Thecomplexityofthesemedicationsmaybeduetothedrugitself,thewayitisadministered,
themanagementofitssideeffectprofile,thediseaseorconditionitisusedtotreat,special
accessconditionsrequiredbythemanufacturer,payerauthorizationorbenefitrequirements,
patientfinancialhardshiporanycombinationofthese.Asaresult,patientsbeingtreatedwith
specialtymedicationsrequirecomprehensivepatientcare,clinicalmanagement,andproduct
supportservices.
Specialtyprescriptionmedicationscannotberoutinelydispensedatatypicalretailcommunity
pharmacybecausethetherapytypicallyrequiresspecialhandlingaswellassignificantpatient
educationregardingappropriateutilization.Typicalretailpharmaciesarenotdesignedto
providethepatientcareorotherservicesthatspecialtymedicationsrequire.

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