The Specifics of Specialty Lite

PC: Back at Asembia, you participated in a panel evolving around how to succeed in specialty lite. What exactly is a specialty lite product, and what was discussed during the session?

Marsh: These medications typically have a WAC [wholesale acquisition cost] price between $500 and $1500, so they're more expensive than a traditional retail product, but they aren't the traditional cost of a specialty product, where it takes more of a white glove specialty pharmacy service to get the patient on therapy. The other definition that we talk about a lot with specialized products is that a lot of these medications in this category are prescribed by a primary care physician, not a specialist. Ensuring that those primary care physicians understand the hurdles that they're going to have to work through, such as prior authorizations that they aren't typically used to when writing medications—standard maintenance medications—is going to be really important. So that's typically how we define it, a kind of a lower WAC than traditional specialty, but a higher WAC than traditional retail, and specialty lite products that are going through the retail channel for dispensing versus through the specialty pharmacy.

Looking back on that panel discussion at Asembia around specialty lite, it was really focused around the uniqueness of the patient journey and the challenges that both the patients and the physicians face, and getting the patient started on therapy. If I use my analogy from earlier around going to your doctor, getting a prescription for an antibiotic, going to your pharmacy, walking out 15 minutes later, this process is similar in terms of it may be a primary care physician that's writing the prescription, the patient takes it to a retail pharmacy, but because of the higher WAC costs for these products versus traditional retail, they're going to face reimbursement and financial hurdles that they don't typically face.

This could mean prior authorizations, potentially an appeal, a high out-of-pocket cost, which then brings up the question of what financial assistance—such as manufacturer co-pay card—is available. It's really about educating both of those stakeholders on what to expect. For the patient, this isn't in and out in 15 minutes. You need to enroll into the patient support hub. There are services that are available.

Then, there’s the physician as well. These physicians typically aren't used to doing prior authorizations. They aren't used to enrolling a patient into a patient support program hub. On that piece, it's really important that we create enrollment channels for the physician to enroll the patient into the hub that are right within their workflow, within the EHR. So that's been a big goal for us that we set out to achieve three or four years ago, to create that enrollment channel that's in physicians’ natural workflow, so that they don't have to pivot to a portal, fill out an enrollment form, but you have to educate both of these stakeholders—the patient and the physician—on what it is that's going to be expected of them, because it is such a unique journey compared to traditional retail medications that are filled.