Specialty Pharmacy - Behind the Scenes

Ig Therapy and Where it Comes From

I think anyone who infuses at home understands the special relationship you create with a specialty pharmacy (SP) on that once a month supply re-order call. I mean, they are the ones that help deal with prior authorizations, make sure your medicines arrive somewhat on time, and make sure you get at least a few of the supplies you actually ordered. I joke because some SPs do this better than others, but we have all been there. I think the reason we as patients sometimes have a complicated relationship with our SP is because they are tasked with helping us with our most dire need, providing our medicine, and some of the people on the phone have a tough time understanding our needs.  Full disclosure, I have been infusing at home since 2001 and I used to work for a large SP. I had the opportunity to join a corporate task force on Ig while there. It really opened my eyes to the very complicated specialty pharmacy world. Let’s take a peek behind the curtain.

Imagine walking into a building, you pass through some offices, and then a security code gets entered for you to be able to enter a warehouse.  Inside the warehouse it almost looks like a grocery store. There are small aisles with shelves full of supplies. Aisle 1 has all the SCIG supplies, aisle 2 has IVIG supplies, and pumps could be picked up on aisle 5 heading to the refrigerator section. Yes, you heard that right, the refrigerator section.  Once you get back there you see a wall of refrigerators similar to what you buy your milk in at the grocery store. Every shelf is full of 20g bottles, 10g, bottles, and so on. One brand takes up the top part while another fills the bottom. People walk around with small carts picking the order like you would shop at the grocery store. That is how your monthly order gets fulfilled. Once it is entered in the system it gets sent to the pharmacy to fill, and then out to shipping. The order should be checked several times throughout this process to ensure it is correct.  Could you imagine if you had access to that, my Saturday’s would be changed forever, “ hey honey I am going to run by Wal-Mart, go get the car washed, and pick up my infusion supplies. I think it’s a 10 gram week for me this week, and I noticed we are low on needle sets.”

I will never forget walking through this specialty pharmacy setup and seeing this product that is a lifeline for so many, sitting in such a novel setting like how I buy my milk. I think that is where the disconnect can sometimes happen between the SP and the patient, at least for me. I look at this product and situation like my lifeline, and unfortunately I am not sure that everyone there really sees it the same way. In all fairness, how could they, unless they themselves were patients or knew someone who was one as well. I use this example as a broader way to show the importance of the relationship needed between the patient and the specialty pharmacy. After touring the pharmacy area, I got to speak with the team that actually takes the calls to fill orders. They are all pharmacy techs, similar to the person who helps you fill your prescription at the local pharmacy. In talking with them we quickly realized they did not fully understand the intricacies of the Freedom 60® pump and corresponding tubing. I looked at their boss as if this is a silly problem to have since I just saw several dozen pumps downstairs in the warehouse. 

So what should you take from all of this? My hope is that this provides a small glimpse behind the curtain. This is only a small piece of the SP role in providing our medication to us every month. I will continue exploring their role in future posts. For now, remember when you call to order your next month’s supplies, take a deep breath when the call goes a different direction, this is a great opportunity to teach and educate. Maybe you make a difference for the next caller and patient after you. Share your best practices for dealing with your specialty pharmacy below. 

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