Specialty vs. retail pharmacy

As a health care provider, your commitment to improving the health of your patients doesn’t stop when they leave your office. This is especially true when it comes to treating patients with serious or complex diseases, who likely receive support from other health care providers.

That’s why it’s important to understand the role of specialty pharmacies and how they differ from retail pharmacies. Learn why these distinctions are important, as well as what specialty pharmacy resources are available to your patients.

How do they differ?

Most people are familiar with a retail pharmacy — one that is located in their community and fills prescriptions that treat common health conditions such as high blood pressure or infections.

In contrast, specialty pharmacies distribute medications that are often high cost, require more clinical support and may even need special handling or administration (like injectable therapies). In doing so, they offer clinical services that go above and beyond what retail pharmacies provide.

Specialty pharmacy resources for patients

People with rare or complex conditions need specialized support. While retail pharmacies may offer convenience, specialty pharmacies act as true partners in patient care. The highest-touch specialty pharmacies provide proactive outreach to patients, guiding them through their treatment — from sourcing financial assistance to providing ongoing clinical support.

Specialty pharmacy patient assistance

To ensure patients adhere to their treatment plans, take their medications as directed and have the best possible health outcomes, specialty pharmacy resources include a whole host of patient assistance, including:

Treatment support and education — Specialty pharmacists and specialty pharmacy support staff have disease-specific training for conditions like multiple sclerosis, oncology, hepatitis, autoimmune disorders and more. This means they can provide adherence support, education, injection training and clinical counseling.

Care planning — Taking a specialty medication can be overwhelming, but specialty pharmacy staff who are highly knowledgeable and trained in specific disease states can help. They work to identify what types of proactive outreach, support and side effect management are most helpful, and provide personalized consultations based on this care plan.

Financial assistance — Because specialty medications are expensive, patients may need help paying for their out-of-pocket costs. Specialty pharmacy experts can direct patients to foundation assistance, vouchers, copay cards and other types of financial help.

An ideal specialty pharmacy partner

It’s specialty pharmacies’ high-touch services, support and clinical expertise that set them apart from retail pharmacies. But not all specialty pharmacies are created equal. When recommending a specialty pharmacy to your patients, providers should consider what types of financial assistance, accreditations and services are available to ensure optimal health outcomes, adherence and patient support. Certain characteristics are essential, such as:

Access to a wide range of medications — It’s important to note that some drug manufacturers only allow certain specialty therapies to be dispensed by a select number of specialty pharmacies. These types of specialty medications are called limited distribution drugs (LDD). Because of this, when selecting a specialty pharmacy partner, the more LDDs available, the better.

Accreditation — The ideal specialty pharmacy is accredited by agencies that inspect and rigorously test their policies, processes and procedures to ensure that standards of care are met. Accreditation ensures providers have a trusted partner in providing the best care possible.

Pharmacist availability — Look for a specialty pharmacy with a wide range of tools and availability. Some specialty pharmacies will even offer 24/7, round-the-clock clinical support via phone, chat or even video consultations.

Pharmacy choices matter

Finally, leading specialty pharmacies support your office with prior authorization, benefits investigation and appeals. Many specialty pharmacies can even initiate, facilitate and manage these processes. An ideal specialty pharmacy works with you to make your job easier and ensures that your patients are supported.

When it comes to prescribing, a retail pharmacy might suffice for many common medications. But when a rare or complex condition calls for high-touch support, Optum provides a hands-on approach to care, a whole host of specialty pharmacy resources for patients, and a true partnership with you in patient outcomes.