An Analysis of COVID-19's Impact On the Specialty Pharmacy Industry

While the entire healthcare industry experienced a rapid evolution due to the COVID-19 pandemic, specialty pharmacy was particularly impacted in unique ways. The same barriers to accessible, affordable specialty therapies that existed prior to COVID-19 were substantially heightened, and continue to present obstacles to today’s patients. 

A Process Disrupted 

In the earliest days of the pandemic, lockdowns and other restrictions upended the process patients typically follow to obtain their treatments and medications. 

In-office visits dropped by as much as 60% at the height of the lockdown period across the US. That decline of in-person visits resulted in a corresponding drop in specialist referrals, and a decrease in prescriptions written and filled.

Though some healthcare providers already offered telehealth and other virtual services pre- pandemic, not all were prepared to leverage these technologies to provide patients with continued access to essential treatments. Even when telehealth options were available, social determinants like lack of internet access left some patients unable to take advantage of these delivery alternatives. 

All the while, healthcare affordability became an even greater challenge during the pandemic. Whether patients’ work hours were cut, they were furloughed when their employers were required to shut down temporarily, or they lost their jobs when their employers went out of business, many individuals were at greater risk of failing to adhere to their treatment plans as a result of financial barriers or the loss of healthcare coverage.

A Changing Specialty Pharmacy Ecosystem 

The complex nature of specialty medical treatments resulted in this industry being especially hard hit by pandemic-induced barriers. The restrictions that kept patients out of providers’ facilities and the economic forces that impacted patients’ ability to pay could not have come at a worse time.

Specialty pharmacy brands had already been under pressure from a growing complexity within the healthcare ecosystem.  Payers and pharmacy benefit managers (PBMs) have consolidated at an accelerated rate, with three-quarters of prescription claims now originating from the top three PBMs. Combined with increasingly alarming health inequalities, unprecedented supply chain constraints, and the specter of major healthcare policy reform, these forces all seemed to collide with the pandemic to create a perfect storm of challenges for specialty pharmacy in particular. 

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How this Impacted Patients 

Since COVID-19 hit, patients requiring specialty therapies have struggled greatly to get the treatment they need, when they need it.

Infusion treatments for autoimmune conditions processed through Medicare declined by as much as 44% in the spring of 2020. According to a presentation given at the most recent Asembia conference, all patients are now 20% less likely to fill a prescription compared to in 2013.

Given that many patients on specialty treatments are immunocompromised- making them more vulnerable to severe COVID-19 infection- it has become vital to provide safe, continued access to therapies throughout the pandemic. But with immunocompromised patients wanting to avoid risk bearing in-person visits, administering hands-on treatments like infusions became incredibly challenging, and providers found it more difficult than ever to monitor adherence. At the same time, the specialty pharmacy distribution system has struggled to ensure availability of critical medications amidst major supply chain disruptions. 

As a result, home healthcare-already on the rise- is seeing an additional spike in demand as providers find ways to bring specialty treatments directly to patients in a safe way. Similarly, the trend toward online ordering and home delivery of medications accelerated as patients adhered to stay-at-home orders, or voluntarily avoided public places due to infection concerns. 

Telehealth services also helped overcome pandemic-related hurdles to healthcare access for patients with complex diagnoses or complicated therapeutic regimens. The ability to visit with a specialty pharmacist virtually to ask questions or discuss concerns proved both useful and comforting during these uncertain times.

The Critical Role of a Digital Shift 

While the pandemic poses tremendous challenges across healthcare in general and specialty pharmacy specifically, a potentially more optimistic transformation is surely underway—one that’s helping providers and patients navigate this new normal successfully. The industry’s continued willingness to embrace digital ways of working is serving as a gateway to breaking down barriers and removing obstacles that threaten patient access and affordability, especially mid-pandemic. 

Automated transactions like electronic enrollment/consent, prior authorization, and benefits review are all helping to speed patient time to therapy, resulting in improved health outcomes. And with less complexity and ambiguity around the cost of treatment and available financial assistance options, patients are gaining the cost transparency they greatly need, especially during times of economic uncertainty. 

In the video below, Mirian Rodriguez, who has been part of the CareMetx team since 2013, witnessed first-hand that simply being able to process an electronic financial assistance application for a patient can make the difference between whether or not that patient pursues a life-saving treatment altogether. Little else could more poignantly underscore the magnitude of impact the digital transformation of healthcare can have on the lives of today’s patients. 

We often forget to imagine how daunting the navigation of this complex landscape can be for patients who are not only unfamiliar with it, but who are simultaneously grappling with the emotional stress of having been diagnosed with a complex, potentially life-threatening illness. 

Consider digitally enabled solutions' ability to improve the patient experience. These tools are able to streamline and simplify the traditionally complex, paper-based, time-consuming processes around obtaining prior authorization, applying for financial assistance, or understanding what portion of a specialty treatment their insurance will cover. Leveraging online portals and self-serve technology to complete those processes became almost a necessity during the pandemic lockdowns. This pressure to adjust in the eleventh hour has now evolved for some leaders to a methodical, strategic shift - one with the potential to get patients on specialty therapies faster and more affordably.