The need for support and advocacy in case management, as well as issues related to disease management, have also resulted in limited distribution networks. For example, if a patient needs additional help, we check that patient`s case: is the patient`s utility due to the pharmacy or medically? Is it retail or mail order? We will distribute the product through a selection channel where the supplement is most advantageous, or we will find alternative coverage. It could be, for example, that a person is eligible for Medicaid but did not know it; In such a scenario, we would help inform the patient about Medicaid and manage the benefits accordingly. The result of all this is to streamline drug dispensing, administration, and management processes so that patients integrate their care, help payers understand their return on investment in specialty drugs, and help manufacturers resolve inventory issues and relationships with MCOs. Despite its general use, the term “special drug” still does not have a consensus definition. Special drugs, at least historically, have typically been characterized as drugs that are both expensive and very complex. The common characteristics of special medicinal products are generally as follows: manufacturers must conclude agreements with specialist pharmacists that protect the professional independence of pharmacists and pharmacists and ensure that no undue influence on their professional judgment is exercised. AKS was adopted to protect patients and public health programs from fraud, waste and abuse related to health transactions that are affected by conflicts of interest. In particular, its adoption arose out of Congress` fear that the remuneration of those who might influence health decisions would lead to the provision of goods and services that are medically unnecessary, of poor quality, or even harmful to patients. Similarly, education and counselling services could lead to off-label promotions, buffers or claims of superiority.
The rapid growth of the specialty drugs market and the rise of specialty pharmacies to serve this market have prompted other intermediaries in the pharmaceutical channel to realize this. Cost managers, Pharmacy Benefit Manager (“PBM”), wholesalers and large pharmacy chains have recognized that some aspects of the special pharmacy model are in line with their economic interests. Over time, this model has developed due to the growing position of consolidated drug channel intermediaries to take advantage of the growth of specialty drugs. Special products represent countless challenges for which sp solutions offer solutions (Table 2, page 34). For patients, two important considerations are cost and access. Retail pharmacy has the challenges of inventory, product knowledge and administrative tools. Physicians need to address issues of inventory, supply, and slow reimbursement, while MCOs have some unusual administrative challenges, primarily related to pursuing claims. Special pharmacies have played and continue to play a critical role in managing some aspects of copay support programs for manufacturers through their existing range of services.
In 2014, there were 561 Copay support programs for more than 700 brand-name drugs; During this period, about 35% of special pharmacy prescriptions were offset by copay support programs….