Specialty Pharmacies Proliferate, Along With Questions



SINKING SPRING, Pa. — As the end of each month nears, Megan Short frets. Her 1-year-old daughter, Willow, cannot afford to miss even a single dose of a drug she takes daily to prevent her body from rejecting her transplanted heart.

Because of stringent rules from her drug plan and the pharmacy she is required to use, Ms. Short cannot order a refill until her monthly supply is three-quarters gone. Yet processing a refill takes about seven days, making it touch and go whether the new shipment will arrive before the old one runs out.

“You just feel like every month, you’re hoping that they don’t mess it up,” said Ms. Short, who lives in this town about 70 miles northwest of Philadelphia.

Ms. Short is not dealing with her corner drugstore but with a so-called specialty pharmacy, a new breed of drug dispensary…

But as specialty pharmacies proliferate, questions are emerging about their role and business practices.

Interviews with patients, patient advocates and doctors suggest that specialty pharmacies do not always live up to their billing. There can be onerous refill policies that require hours on the phone, shipments that are delayed or error-ridden, and difficulty reaching a pharmacist or other representatives.

Moreover, many patients are limited to one specialty pharmacy — often one owned by their insurer or pharmacy benefit manager and requiring delivery of drugs by mail. That leaves patients without options if they are dissatisfied…

Consumer Watchdog, a consumer advocate group, has sued four insurance companies over their policies of restricting the pharmacies that patients can use to obtain drugs for H.I.V. Three of the companies — Anthem Blue Cross of California, UnitedHealthcare and Aetna — have since changed their policies to provide more options for H.I.V. patients. The most recent of the lawsuits, against Cigna, was filed in April…

Federal prosecutors are seeking as much as $3.3 billion in a whistle-blower lawsuit against the drug maker Novartis…  Accredo, the specialty pharmacy owned by Express Scripts, agreed in April to pay $60 million to settle civil fraud charges in this matter…

One thought on “Specialty Pharmacies Proliferate, Along With Questions

  1. i can see the pain pill dispensaries moving from the regular ones (that don’t want to fill opiates anymore) to these new ‘specialty’ pharmacies, and that brings with it another whole new batch of complications.

    Liked by 1 person

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