The field of medicine is one of the most studied areas of science for a good reason. With thousands of diseases affecting millions of people around the world, it’s been a mission for many countries to find the right treatments and medications to improve quality of life and prevent mortality rates from skyrocketing to unprecedented numbers.

But while most of us know about popular diseases like diabetes mellitus, cardiovascular disease, cancer and hypertension, there are also those orphan diseases that are so rare they only affect a small percentage of the world’s population. They are usually treated using medications called orphan drugs.

Orphan diseases and orphan drugs: A closer look

 To gain a better understanding of orphan drugs, we need to learn about what orphan diseases are and how they affect the world’s population.

Orphan disease defined

A disease is categorized as a rare or orphan disease when it only affects a small number of people in comparison with the general population. In European standards, for instance, a disease is considered rare when it affects only one in every 2,000 individuals. In general, 1 in 17 people will suffer from a rare disease in their lifetime.

Today, there are at least 7,000 types of rare diseases, many of which are considered chronic and life threatening. Most orphan diseases also appear early in life where 30% of children affected by them die before their fifth birthday.

More than 250 new medical conditions are also being described in medical literature every year. However, there is still no proper definition of orphan diseases because they differ in each territory.

The most notable orphan diseases

Medical breakthroughs and the development of orphan drugs may have saved millions of lives, but more than 350 million people around the world are still suffering from a group of orphan diseases. The most common types of rare diseases include:

• • Multiple sclerosis

Multiple sclerosis is a potentially disabling disease of the brain and central nervous system where the immune system attacks the myelin sheath that covers the nerve fibers causing miscommunication problems between the brain and the rest of the body.

It affects 90 in every 100,000 individuals and if not treated with orphan drugs, it can cause permanent damage to the nerves.

• • Narcolepsy

Narcolepsy is a neurological disorder where the individual has difficulty controlling sleep and wakefulness. It is characterized by hallucinations, excessive sleepiness, sleep paralysis and even episodes of cataplexy where the patient experiences partial or total loss of muscle control. Narcolepsy affects 50 in every 100,000 individuals.

• • Primary biliary cholangitis

Formerly known as primary biliary cirrhosis, primary biliary cholangitis is an autoimmune disease of the liver resulting from a slow and progressive destruction of the liver’s small bile ducts. This results in a buildup of toxins in the liver called cholestasis. This orphan disease affects 40 in every 100,000 individuals.

• • Fabry disease

Also known as Anderson-Fabry disease, this rare genetic disease is part of a group of conditions known as lysosomal storage disease. It affects the skin, kidneys and heart due the genetic mutation that interferes with the function of sphingolipids. Fabry disease is usually diagnosed in childhood and affects 30 in every 100,000 individuals.

• • Cystic fibrosis

Cystic fibrosis is a rare inherited disease that affects the lungs, digestive system and other organs of the body. A defective gene that affects the cell’s ability to produce sweat, mucus and digestive juices usually causes the disease and it affects 25 in every 100,000 individuals.

Orphan drugs defined

With at least 90% of the known orphan diseases still lacking treatment, the need for high quality orphan drugs has never been more important. An orphan drug is generally defined as a pharmaceutical agent that is developed specifically to treat medical conditions called rare or orphan diseases.

Because orphan drugs are used for conditions that are so rare, developing them would not be profitable enough for private pharmaceutical companies without the help of the government.

In many countries, research and development for orphan drugs is often a subject of public policy and those with the right support from the government have resulted to breakthroughs that otherwise might not have been possible if only private companies funded them.  But patients with orphan diseases are still spending more for treatments because orphan drugs are priced higher because of their limited availability.

As of 2014, 281 orphan drugs are available on the market while more than 400 are still undergoing clinical trials. The United States is leading the development of these drugs with more than 300 clinical trials underway followed by Europe. There is a total of 600 clinical trials today, 231 of which are on phase 2.

The cost of orphan drugs

Since orphan diseases are not widely known around the world, the cost of developing orphan drugs are considered higher than traditional drugs. However, many countries are starting to find ways to back the research and development of these drugs to help give patients better quality of life.

The United States is leading the charge with government-backed incentives like tax credits for the cost of research and development and clinical trials. This will help lower the cost of orphan drugs and speed up their delivery to the market. Countries like Australia, Europe and Japan are also following the same strategy.

The estimated worth of pharmaceutical companies focusing on developing medications for rare diseases are about half a trillion, roughly about 17.5% of the total value of the big pharmaceutical industry. The total enterprise value of the market is at $508 billion.

In the United States, the average cost of an orphan drug for every American patient can reach up to $151,000 per year as compared to only $34,000 for non-orphan drugs. This cost is set to grow further in the future, as orphan drugs will make up one-fifth of the total prescription sales around the world by 2024.

It’s easier for pharmaceutical companies to get marketing approval for an orphan drug in the United States and Europe because of initiatives that are geared towards encouraging the development of these types of drugs. This can include financial incentives and extended exclusivity periods for producers to enjoy sole rights to market their drug.

The Orphan Drug Act (ODA) of 1983

On January 4, 1983, President Ronald Reagan signed the Orphan Drug Act (ODA) into law to help incentivize the research and development of orphan drugs.

• • What is the purpose of the act?

The main goal of the ODA is to encourage pharmaceutical companies to develop more drugs to treat rare or orphan diseases.

The act was amended in 1984 to classify rare diseases as those affecting less than 200,00 people in the United States, but it also covers drugs for medical conditions that affect more than 200,000 but the cost of making them would exceed their revenue if marketed in the United States.

• • What are the incentives of the ODA?

One of the biggest incentives provided by the ODA is the 7-year marketing exclusivity of orphan drugs for pharmaceutical manufacturers. This gives them the chance to get their investment back without pricing their drugs too high. The ODA also awards several grants to academic-based researchers and pharmaceutical companies annually for the development of orphan drugs and offers a 50% tax credit for expenses incurred during the evaluation of an orphan drug.

There are also some exemptions given only to companies developing orphan drugs. Although they follow the same development path as regular drugs, the government acknowledges that since rare diseases affect only a small percentage of the population, it may not be possible to test the drug on 1,000 patients during a phase III clinical trial.

• • What is the impact of the ODA?

Since it was enacted in 1983, the ODA already had a huge impact on the development of orphan drugs. A 2011 paper by Aaron S. Kesselheim of the Harvard Medical School showed that from a single orphan designation in 1983, the number increased to 40 in 1984 and as high as 121 in 2007.

From January 1983 to May 2010, the FDA already approved 353 orphan drugs and granted designations to 2,116 compounds. And as of 2010, 200 of the 7,000 officially designated rare diseases are now treatable.

Roche is one of the biggest manufacturers of orphan drugs in the world producing Rituxan, a drug primarily used to treat rheumatoid arthritis. When combined together with another Switzerland-based company Novartis, both companies were able to generate more than $20 billion in worldwide revenues for orphan drugs in 2018.

Although not designated as an orphan disease, the FDA has approved the use of the ODA for the research and development and creation of orphan drugs to treat AIDS. In 1995, 13 of the 19 FDA-approved drugs were designated orphan status, 10 of which have received marketing rights. There are also more than 70 designated orphan drugs for the treatment of other HIV-related conditions.

• • What are some of the popular orphan drugs?

With the help of the ODA and EU legislation, several orphan drugs have been developed to treat rare diseases such as cystic fibrosis, glioma, snake venom poisoning, multiple myeloma and phenylketonuria.

One of the first orphan drugs to be developed was for cystic fibrosis. In the 80s, patients diagnosed with this rare disease didn’t survive beyond their early teenage years. But with the development of Tobramycin and Pulmozyme, the life expectancy and prognosis of patients with cystic fibrosis have improved immensely.

Wilson’s disease is another rare disease that’s now treating using an orphan drug. The hereditary medical condition results in the body accumulating fatal levels of copper. Penicillamine was developed specifically for the treatment of Wilson’s disease, but it has been tested to be effective in treating arthritis as well. Another drug, Bis-choline tetrathiomolybdate is now under investigation as another treatment for the disease.

Another huge breakthrough in orphan drugs is the development of statin drugs to treat familial hypercholesterolemia. Two researchers who worked on the drug, which is now used to treat high cholesterol received a Nobel Prize in 1985.

• • What is the future of the ODA?

While the goal of the ODA is clearly benefiting those suffering from orphan diseases, the act hasn’t been free from controversies. Some skeptics believe that pharmaceutical companies are manipulating the benefits of the ODA to take advantage of bigger revenues.

According to America’s Health Insurance Plans, the pharmaceutical industry has reportedly “gamed the system” by turning orphan drugs into multibillion-dollar products. An investigation published by Kaiser Health News in 2017 showed some drugs being designated as orphan drugs after first being designated as non-orphan.

These issues are not falling on deaf ears. Last year, FDA Commissioner Scott Gottlieb, MD said that he was open about the possibility of re-evaluating some aspects of the Orphan Drug Act. In a statement to Kaiser, Gottlieb said that it’s time to ask, “Do we have the right incentives in place?” He also mentioned in a separate blog post that the agency would study the proper application of orphan incentives.

The Rare Diseases Act was also enacted in 2002 to amend the Public Health Service Act, which aims to properly designate and control orphan diseases and orphan drugs. The act also increased funding for the research and development of orphan drugs to help people suffering from orphan diseases.

The European Union (EU) has followed suit in enacting a similar legislation from the ODA. In 2000, Regulation (EC) No 141/2000 was enacted and it referred to orphan drugs as “orphan medicinal products.”

Aside from diseases affecting only a small number of the world’s population, the EU’s definition of orphan diseases also include some tropical diseases that are mainly found in developing countries. The European Commission offers a 10-year marketing exclusivity benefit for an orphan drug after its approval. The European Medicines Agency (EMA) and the Committee on Orphan Medicinal Products administer this legislation.

Over the years, other countries have also implemented legislations that support the development of orphan drugs. Nations like Singapore, Japan and Australia have offered subsidies and other incentives for researchers and pharmaceutical companies that want to develop drugs to treat different orphan diseases.

U.S. pharmacists received a startling reminder of the urgent need for drug safety, when in November 2019, a statement was issued by the Drug Enforcement Agency (DEA) warning the public about an alarming number of counterfeit pills that had been seized throughout the nation.  “Mexican drug cartels are manufacturing mass quantities of counterfeit prescription pills containing fentanyl, a dangerous synthetic opioid that is lethal in minute doses, for distribution throughout North America,” the statement read.

The DEA said that 27 percent of the drugs seized contained potentially lethal doses of fentanyl.  Special Agent in Charge Ray Donovan, of the agency’s New York Division warned:  “Counterfeit pills have hidden dangers causing one in four users to die, according to DEA field testing.  This is a warning and a plea for parents to talk to their children about using counterfeit or diverted prescription pills – either one of them ends with death and/or devastation.”

News of the surge in potentially-lethal drugs comes as U.S. drug manufacturers, wholesale distributors, pharmacies and other parties involved in prescription drug distribution continue to implement key provisions of the 2013 Drug Quality and Security Act, which is intended to prevent counterfeit, stolen, contaminated or otherwise harmful drugs from entering the nation’s drug supply chain.

 

Drug Supply Chain Security Act – Working Toward a Track-and-Trace System

Specifically, Title II of that legislation, the Drug Supply Chain Security Act (DSCSA) mandates creation of “an electronic, interoperable system to identify and trace certain prescription drugs as they are distributed in the United States.”  The system, referred to as “track and trace,” is being spearheaded by the U.S. Food and Drug Administration (FDA), and is mandated to be operational by 2023.  When fully implemented, the system will be capable of tracking a drug at the unit level throughout its supply chain.

The FDA is working to build that system, namely by working with supply chain stakeholders, and through a pilot program that was launched earlier this year to identify, build, and test required capabilities.

DSCSA Implemented in Phases

As that work continues, progress is being made to implement other provisions of the law.

 

A. Product Tracing

In 2015, manufacturers, wholesale drug distributors, repackagers and dispensers (primarily pharmacies) were required to provide information about the handling history of each drug sold in the U.S. market.  Specifically, each drug transaction must now be accompanied by three separate documents that include FDA-required information including:

          Transaction information (TI)

• • • • Proprietary or established name of the product
      • Strength and dosage form of the product
      • NDC number of the product
      • Container size
      • Number of containers
      • Lot number of the product
      • Date of the transaction
      • Date of the shipment, if more than 24 hours after the date of the transaction
      • Business name and address of the person from whom and to whom ownership is being transferred.

          Transaction history (TH)

A statement in paper or electronic form, including the transaction information for each prior transaction going back to the manufacturer of the product.

Transaction statement (TS)

A statement, in paper or electronic form that affirms the following points:

• • • • The entity transferring ownership in a transaction is authorized as required by DSCSA;
      • The product was received from a person who is authorized as required by DSCSA;
      • Transaction information and a transaction statement were received from the prior owner of the product, as required under the law;
      • The entity did not knowingly ship a suspect or illegitimate product;
      • The entity has system and processes in place to comply with verification requirements under the law; and
      • The entity did not knowingly provide false information, and did not knowingly alter the transaction history.

B. Product Verification

Also beginning in 2015, stakeholders are required to have in place systems and processes to comply with product verification requirements.  Specifically, this includes the ability to handle “suspect” and “Illegitimate products” that may be counterfeit, diverted, stolen, intentionally adulterated or appear otherwise unfit for distribution.

Stakeholders must have in place a process to:

• • Respond to verification requests from the FDA about suspected products;
  • Quarantine and investigate any suspect product to determine if it is illegitimate;
  • Notify trading partners and the FDA of any illegitimate product;
  • Respond to notifications of illegitimate product; and
  • Satisfy recordkeeping requirements.

C. Product Identification (Serialization)

The law established requirements for manufacturers and repackagers to print or affix a unique product identifier on the smallest individual sellable unit.  The product identifier is composed of four specific data elements:

• • National Drug Code
  • Serial number
  • Lot number
  • Expiration date.

The product identifier must be “human and machine readable,” with a two-dimensional (2-D) bar code adopted as the standard for machine processing.

The law sets out specific deadlines for compliance within each stakeholder group:

• • November 2017: Manufacturers
  • November 2018: Repackagers
  • November 2019: Wholesalers will only trade products with product identifiers
  • November 2020: Dispensers (Pharmacies) will only trade products with product identifiers.

2019:  Pharmacy Specific Requirements

Pew Charitable Trusts refers to pharmacies as “the last stop in the distribution supply chain before medicines reach patients,” and calls their participation “an essential component of the new DSCSA system.  It’s not surprising then, that several of the important components already implemented, directly affect pharmacies.  Current pharmacy responsibilities include:

1. Confirm all trading partners are properly licensed or registered.

a. Check the registration of manufacturers and repackagers by accessing the FDA’s Drug Establishments Current Registration Site — DECRS.

b. Check the licensing of wholesale distributors and third-party logistics providers. This can be done by searching the FDA’s Wholesale Distributor and Third-Party Logistics Providers Reporting database.

c. Check the licensing of pharmacies through the respective state authority.

2. Receive, store and provide product tracing documentation.

a. Only accept prescription drugs that are accompanied by three pieces of product tracing documentation:

i. Transaction Information

ii. Transaction History

iii. Transaction Statement.

b. Store the product tracing documentation in paper or electronic format for six years.

c. Generate and provide all product tracing documentation whenever a prescription drug is sold to a trading partner. (This documentation does not need to be provided when a prescription is dispensed to a patient, or sold to another pharmacy for dispensing to a patient.)

3. Investigate and properly handle suspect and illegitimate drugs.

a. Quarantine and investigate suspect prescription drugs to determine if they are illegitimate.

b. If a drug is found to be illegitimate, a pharmacy must work with the manufacturer and take specific steps to avoid inadvertent dispensing to patients. The pharmacy must also notify the FDA and the trading partner from whom the drug was purchased, and to which it may have been sold.

Looking ahead, pharmacies will face additional responsibilities that include:

• • 2020: Pharmacies will only be permitted to purchase products that include a unique product identifier.
  • 2023: The entire drug supply chain – including pharmacies – will be required to utilize the electronic track-and-trace system.

 

Protecting Drug Safety – the Role of Technology

As the “final link” in the drug supply chain, pharmacists have a tremendous role in the successful implementation of the DSCSA.  By the time a drug is received by a pharmacy, it has already passed through several other trade partners, and is just one step away from being dispensed to a patient.

Therefore, pharmacies must have a fail-safe process in place to ensure — not only full compliance with DSCSA – but accuracy and safety of its overall operations.  In today’s busy pharmacies, that process increasingly comes in the form of a fully-integrated technology system.  Certain technology solutions, including the PrimeRx™ system offered by Micro Merchant Systems, can allow a pharmacy to seamlessly manage compliance requirements, monitor patient wellbeing, protect against expired drugs, and seamlessly maintain records and documentation.

Important to note though, not every technology system offers the same capabilities.  This means a pharmacy manager must spend time carefully reviewing different systems, to ensure a system has the required functionality.  With regard to compliance with the Drug Supply Chain Security Act, for example, it’s important to ensure that a system’s manufacturer is aware of the evolving requirements, and understands the need to provide required capabilities.  With regard to PrimeRx™, DSCSA and safety-related competencies include:

Access to National Drug Code and other databases.  Pharmacies have long recognized the need for immediate access to the National Drug Code listing as a way to verify prescribed medications and list proper drug codes on all documentation.  Going forward, the NDC code will be an integral part of each drug’s unique identifier, which means access to the NDC registry will be essential.  In addition, pharmacies must have access to the required FDA databases to validate trading partners’ proper licensing and certification.  PrimeRx™ offers seamless access to this information, and allows pharmacy staff to quickly confirm and document all required information.

Recordkeeping.  The PrimeRx™ system offers extensive recordkeeping that allows pharmacy managers to efficiently store documentation and information about essentially all aspects of pharmacy operations.  This includes the ability to record unique notes and observations about patient interactions, along with extensive medication histories.  The system also allows for detailed inventory-related records management, including chains of custody for all drugs, expiration dates, and dispensing histories.  With regard to DSCSA compliance, the system can seamlessly process and store mandated transaction documents.  Should those documents need to be transmitted to another pharmacy, the system can automatically send the required materials.

Report generation.   In addition to storing this information, PrimeRx™ allows the pharmacy manager to generate detailed reports on a wide range of patient, inventory and operations topics.  This includes reports to satisfy FDA information requests regarding specific transactions, or drug investigations.  Should a pharmacy determine that a drug is illegitimate, PrimeRx™ can facilitate compliance with all FDA reporting requirements.

Bar Code Scanning.  Since the DSCSA requires all product identifiers to be available in 2-D format, it’s essential for a pharmacy technology system to be able to easily import that information.  PrimeRx™ offers the required scanning capability, and allows for information to be quickly and accurately loaded and filed.

Continuous Upgrades.  Micro Merchant Systems is a leader in the pharmacy technology industry, and has long been a pioneer in anticipating pharmacy needs.  As the FDA continues its work to identify core components of the national track-and-trace system, Micro Merchant Systems will again be at the forefront with required capabilities.  As such, PrimeRx™ customers can be assured that as the system is developed, the necessary software upgrades will be provided in a timely, efficient manner.

Counterfeit and contaminated drugs pose a legitimate threat to the global drug supply chain.  The World Health Organization reports one in 10 drugs sold in developing countries is fake or substandard, “leading to tens of thousands of deaths, many of them of African children given ineffective treatments for pneumonia and malaria.”

And while developing countries may bear the brunt of the counterfeit drug problem, no country is immune.  In a single week, officials from Health Canada seized $2.5 million worth of fake pharmaceuticals at the border.  Earlier this year the WHO reported on fake leukemia medicine circulating across Europe.  And in the United States, which has the safest drug supply in the world, as many as 19 million Americans buy medicines from foreign online pharmacies or other unlicensed sources.

Clearly, the DSCSA comes at a good time for the U.S. prescription drug industry – and American consumers. And armed with a fully-integrated technology system, the nation’s pharmacies will continue to be at the forefront of efforts to protect patients from harmful prescription drugs.

Transcript Below

“It feels as if I’m wasting my money. I advertise and nothing happens”

As a pharmacy owner who has tried Facebook ads (or any advertising), you know you’ve said that before.

I feel your pain. I’ve said it before too.

When I first started using Facebook ads, I had read so many great things about it that I assumed I’d put an ad up and within minutes customers would be knocking at my door. Instead, a day would go by and nothing. Another day would pass, and more silence. By the 4th day, I’d pull the ad.

I would do this with all of my advertising, and month-by-month I’d be shocked that I wasn’t growing as much as I thought I would. Finally, after a few years of mediocre growth, I hired a business coach, and that’s when I was reminded of the fundamental truth in all advertising with 10 simple words.

The fundamental truth – people will only buy from you if they know, like, and trust you.
And guess what?

No one is going to get to know, like, and trust you after just ONE ad. In fact, research says it often takes 8+ ads to get someone who doesn’t know you to buy from you.

For example, last night I purchased this 3D printer for my daughter.

I had never dealt with the company before nor have I even heard of them. So, guess how many ads it took me to pull the trigger and make the purchase?

Easily over 12 ads.

The very first ad I saw was a video ad on Facebook. Intrigued by the 3D printer, I clicked the link and went through the website. Although I immediately thought my daughter and nephews would love it, I didn’t make the purchase. I guess I didn’t want to make a $350 impulse buy.

Then the very next day I get on Instagram, and I see another ad for it. Over the next 5 days, I was bombarded with ads for it on Facebook and Instagram (the beauty of the Facebook pixel and remarketing). I watched every video, read every comment under the ads, and learned as much as I could about it. I visited the website at least 5 different times and even had it in my cart 2 different times. Finally, I made the purchase.

Now, if the old me was running that company, I would have given up after the first ad and lost a $350 sale. Not now though. Now that I understand the value of building “top-of-mind-tip-of-tongue” awareness, I would have been relentless just like that company was. Is it any surprise that that company is going to be featured on Shark Tank? They have a great product and know how to market it.

Think about this for a second….
Do you ever purchase anything from a company you don’t have a relationship with after just one ad? Doesn’t it usually take 3, 4, or even 10 ads before you pull the trigger? You’ll read the comments, search for reviews, talk to friends about it, and possibly even email the company before you make the purchase. Right?

So, obviously, our marketing wasn’t the problem. Our patience was.

What’s the takeaway then?
It’s extremely important that if we want to grow, we need to invest in marketing that’s designed to build “top-of-mind-tip-of-tongue” awareness, or as some marketers call it omnipresence.

Why?

Because almost all of the people we’re targeting are probably already patients at another pharmacy. After one ad, they probably aren’t likely to switch over. However, if they keep seeing your face everywhere, read glowing testimonials, and appreciate the value you put out in your content marketing, as soon as they do think about switching pharmacies, you’ll be the first pharmacy they think about.

Right now there are thousands of unhappy patients at Walgreens and Walmart. Between the poor customer service, the long wait times, and the prices, they’re constantly triggered.

Why don’t they leave then?

Simple. They don’t know they have another option. That is unless there’s an astute independent pharmacy owner in their area that’s constantly building top-of-mind-tip-of-tongue awareness.

So how can a pharmacy build “top-of-mind-tip-of-tongue” awareness using Facebook ads?
A Simple 15-second video targeting your entire zip code
This doesn’t have to be Oscar-worthy. Some of the most successful videos are made with nothing more than an Iphone. A simple, “Hi, I’m John Smith, owner of John Smith’s pharmacy in Smithville, IL. If you’re not getting great service from your pharmacy, I’d love to have you as a patient.” A few bullets with things like free delivery, no long lines, etc. Bam. It’s done. Budget $5 per day and run it for a few weeks, alternating between a few different videos/ad copies. As soon as the mere thought of switching pharmacies pops in your market’s head, they’ll think of John Smith.

A geo-targeted Facebook ad around the local physicians’ offices
Smart marketers know that if they can get in front of potential customers at the right time, they’ll have a much higher likelihood of turning them into actual customers. When is a person most likely to need your services? You guessed it – after leaving the physician’s office.

With this ad, we’ll drop a pin at the address of the physician’s office, limit it to only mobile devices, and even geofence around the physician’s office so the ad is limited to just the physician office and not the 1-mile radius around it you’re limited to with a pin drop. Our hope is that as patients are browsing Facebook or Instagram on their phones in the waiting room, our ad will pop up with our services. Bam. “Top-of-mind-tip-of-tongue” awareness. Budget $5 per day. This ad can run for months since most people aren’t at the doctor every day.

A geo-targeted Facebook ad around your competitor’s pharmacy.
Not too long ago a pharmacist posted in one of the independent pharmacy Facebook groups I’m a part of about how opening his pharmacy across the street from Walgreens was the best decision he’s made. In his words, Walgreens essentially acts like a funnel for him, bringing in new patients almost daily.

Unfortunately, we all can’t pick up our pharmacy and move it next to a CVS or Walgreens. However, with Facebook ads, we can do it virtually. Drop a pin at the address of your competitor, select only mobile devices, and geo-fence around it so your ads will only be shown to people physically at the pharmacy, not the 1-mile radius dropping a pin is limited to. As Walgreens makes a patient wait 30 minutes for a prescription, he’ll be browsing Facebook, see our ad, and realize there’s a more convenient solution.

Pro tip: If you know your competitor’s weakness, include that in the ad. For example, the large majority of patients we get from Walmart come to us because of the 30+ minute wait at the Walmart pharmacy. If we were targeting this WalMart, the first line of our ad would say something, “Are you tired of waiting for your prescription? We know your time is limited so we can get you in and out of the pharmacy in 10 minutes.” A $5 per day budget is ideal. This ad can run for months since patients will see it infrequently.

What were those 10 simple words that completely changed how I advertise?
If they don’t know you, they won’t buy from you.

Top-of-Mind-Tip-of-Tongue Awareness.

Author: TJ Allan

Physicians didn’t spend long years in school to have two-thirds of their work-day be comprised of data entry task.

Pharmacists didn’t spend long years of school to have two-thirds of their work-day consist of filling and dispensing medications.

Both professions went to school so that they can perform at the top of their license and modernize today’s healthcare era; bringing revolutionary solutions to the healthcare industry. It’s already apparent that we prefer to avoid the administrative burden, as it disrupts our workflow and takes time away from spending with the patient.

Our reimbursement model has changed and went from fee for service to now value-based care.

Physicians are the Medicine experts, while Pharmacists are the medication experts. Both professions are considered predominant healthcare leaders in the industry.

Physicians are the first point of contact to diagnose and assess appropriately, while Pharmacists are the last line of defense to verify that the appropriate treatments were prescribed.

It’s clear that both professions possess a high pedigree of clinical knowledge.

Why do we separate the two entities, instead of bringing them closer together?

Primary-care physicians, participation in a care-team program can ease the burden associated with the management of complex-care patients. It also provides a way to better manage the cost of these patients by optimizing their health and functional status, decreasing excess healthcare use, minimizing emergency department visits and other hospital utilization (including readmissions), and preventing long-term nursing home placement.

What’s going on in the Physician private practice world, is also going on in the pharmacy private practice world.

According to the American Medical Association, less than half of physicians own their medical practice. “First-time ever” its been this low.

According to the NCPA (National Community Pharmacist Association) digest report, there has been a steep drop in independently owned pharmacy practices compared to previous years.

Ownership and employment shifts reflect the industry’s increasing compliance costs and new payment models.

Health systems have been aggressively mopping up the physician practices, while the Large-chained pharmacies have been aggressively mopping up the small mom and pop independent pharmacies.

The common reasons shared for selling their practice:

•  Low reimbursements
•  High overhead cost
•  Burnout
•  Increased competition by bigger players
•  Lack of innovation

With the collaboration of Physician and Pharmacy private practices, it can help eradicate a bulk of the problems both professions face and help revolutionize healthcare.

Ways a Pharmacist can help improved value-based care models for Physicians:

•  Disease-state management therapy– Most physicians are trained only to know the contraindications of medications for individual disease states. Where they may lack is the Pharmacokinetics/Pharmacodynamics profile, Medicinal chemistry, and the robust intelligence of clinical literature of drugs in certain classes. All of these small intangible things relating to a drug have a significant impact on its effectiveness.
•  Primary care Pharmacist plans– Yes, Pharmacist can provide care plans. A clinical pharmacist can also put together a care plan to better assess the patient and provide useful treatment recommendations for the Physicians review. This can help reduce the administrative task physicians may have to deal with, which in return allows the physician to spend more time with their patient to go over the pathophysiology of their condition.
•  Pharmacoeconomics– the Pharmacist, have the due-diligent training to evaluate the cost and effectiveness of a pharmaceutical agent against another. This can be referred to as a cost-benefit analysis.  Hence, pharmacoeconomics can help guide optimal healthcare resource allocation and provide more buy-in from Insurance companies.

How can a Physician be of aid to a Pharmacist:

•  Pathophysiology– Physicians are experts and well-trained in the pathophysiology of a patient. This is knowledge pharmacist may lack the substance of knowledge in pathophysiology. Physicians are sharply intelligent in diagnosis criteria’s and general assessment of a patient.
•  Medical Knowledge– Physicians have the medical knowledge to help consult with patients on preventative skills to live a more proactive healthy lifestyle. The more time the Physician has with the patient, the better the outcomes.

In hindsight, Physician & Pharmacist collaboration has the potential to create a robust HealthSystem for patients and also produce a stronger buy-in from insurance companies.

Population health is the current and future trend of healthcare. We can start synergizing our talents and bring out the best in value-based care practice models.

The more prominent players are already adopting vertical integration strategies to help create a more user-friendly and efficient healthcare system. Why can’t we?

In essence, “we have to STOP advertising and START innovating.”

 

How many times has a patient presented to you a prescription for a “specialty medication” that you are unable to fill?  It could be that you are not able to order the medication from your wholesaler. Or worse, the patient’s insurance is mandating a specific pharmacy different than yours.  It can be frustrating when a current or prospective customer is coming to you, the pharmacist, for a solution to their chronic and sometimes rare, condition.

 

There is no finite definition for what qualifies as a “specialty medication“.  In general, specialty medications are used to treat chronic or complex conditions and usually require special handling or administration and close monitoring of the patient.  Sometimes, these prescription medications are indicated for rare diseases, which means that the disease affects less than 10,000 people. And they are therefore given “orphan drug status” under the Orphan Drug Act of 1983.  This Act allows for fast-track FDA approval for drugs intended to treat these rare diseases due to limited therapies available on the market.  Obtaining fast-track approval allows the medicine to be available as quickly as possible to the patients that need it the most.  This also means that the medication does not have to go through as many lengthy clinical studies as the “more” traditional therapies.  Often, as a stipulation of being given fast-track approval status, the FDA may require additional aftermarket studies to be completed, meaning that the drug is available to be prescribed but the patients taking the medicine are monitored for safety and efficacy of the therapy.  This is referred to as a Phase IV clinical trial.  Any pharmacy that dispenses one of these drugs must understand this process and accommodate the patient and drug manufacturer for any required documentation or data.

 

Some specialty drug manufacturers may limit the number of pharmacies who have access to order their medication.  These are deemed “Limited Distribution Drugs,” or LDDs for short.  When attempting to order one of these medications from your wholesaler, you may notice that the drug’s name is not listed in the system. Or it may take you straight to a screen that reads, “due to manufacturer limitations, this product is only available through a limited distribution network” and to contact the manufacturer directly.  This can be very disheartening for a pharmacist or pharmacy owner.

 

Upon calling the manufacturer, you may find out that in order to gain access to this drug, there are many rigorous requirements to meet first.  It is also worth mentioning that all manufacturers are different and have different specifications that must be met.  Many require weekly data reports so it would be prudent to know if your pharmacy’s dispensing software can accommodate customized and automatic reports.  The manufacturer may also request proof that you, as the pharmacy, have a way to monitor the patient for adherence and therapy response.  A common theme among these manufacturers is some sort of “specialty accreditation”.  This is often the first step to becoming a Specialty Pharmacy.

 

Achieving accreditation proves a commitment to quality and standards that are becoming the norm in the specialty space.  Accrediting bodies such as the Accreditation Commission for Health Care (ACHC) and the Utilization Review Accreditation Commission (URAC) are arguably the most reputable in the field.  Both sets of standards set the stage for core activities such as:

o   Patient Care

o   Coordination of Care and/or Delegation

o   Information Management

o   Compliance Program

o Quality Management and Continuous Quality Improvement, etc.

Accreditation is strongly recommended but could become mandatory by payers in the near future in order to ascertain preferred contracts for reimbursement purposes.  This means extra revenue for your pharmacy by adding a specialty line of business.  The entire process can take up to six months to a year for full accreditation and can be very arduous and labor intensive.

 

If all of this is intimidating to you, just know that you are not alone.  The key is to connect with a professional who has been through the process. Ideally, they should have been able to achieve and has maintained accreditation for some time.  Embarking on a project like this size could be overwhelming and a competent expert can guide you through the process.

 

There are many resources available though, if you choose to take on a project independently.  However, there is a lot of competition out there in specialty pharmacy but accreditation can set you apart from others.  Visit www.ACHC.org or www.URAC.org to learn more about the various programs in accreditation.

 

 

We recommend using CSI Specialty Group for all of your specialty pharmacy consulting needs. Click Here 

 

For a long time, the pharmacy space was dominated by big and long-established pharmacies. There was a major lack of startups and innovators were also lacking.

It was only recently when there was a rapid growth in pharmacy startups that areas in the pharmacy space, that have remained untouched for a long time, were disrupted. These include medication dispensing, delivery, cost-savings, prescribing, information, storage, vitamins and supplements, and specialty pharmacy services.

Below is a list of startups that have excelled in one or more areas of the pharmacy industry that are in need of improvement.

1. DeliverCareRx

DeliverCareRx takes medication delivery to another level. Not only does the pharmacy offer free home delivery for more than three prescriptions per month but also synchronizes your prescription needs. This means your prescriptions are delivered to your door at the exact time that you need to replenish your supply.

This makes prescription acquisition convenient and timely. You never have to miss a refill for any reason. This also saves you money from fare or gasoline.

DeliverCareRx also offers free prescription management. No need to go to the doctor’s office and visit your insurance provider because they will handle the scripts/paperwork for you.

2. ZappRx

ZappRx offers patients a quick and easy way to process the specialty drug orders through the ZappRx digital platform. You can order specialty medications online quickly and easily.

Considering that specialty prescribing takes time, the shortcut that the pharmacy offers makes a huge difference. Apart from streamlining the process of specialty med ordering, ZappRx also helps with the communication between providers.

3. NowRx

NowRx hand delivers your prescription medication the same day you place your order. Since you only need to use an app to place an order, you can skip the long queues and have your prescription filled without leaving home.

You can send your prescription to them or have your doctor send it directly to the pharmacy. So after your checkup, you can go straight home instead of going to the pharmacy to purchase your prescription because your doctor can send the prescription on your behalf.

Upon fulfillment, you will receive a notification. Your card will be charged automatically.

You also have an option to video chat with your pharmacist for consultation and for whatever queries you might have.

4. Blink Health

Blink Health lets you buy your prescription meds at a more affordable price. They guarantee the lowest drug prices on all generic medications.

This is one of the startup drug companies dedicated to providing patients with medication cost savings. Unlike other pharmacies offering the same service, Blink Health does not require membership fees or coupons.

You can also pick up your prescription medication at local pharmacies near you. Just pay online and your order will be ready for pick up. Enjoy an average of 70% cost saving per prescription filled.

5. GoGoMeds

Run by Specialty Medical Drugstore, a full-service pharmaceutical provider based in Greater Cincinnati, GoGoMeds offers low-cost prescription medications and other specialty pharmacy services.

You can have your prescription filled without the need to leave your home. Just send your prescription via mail or have your doctor fax it directly to specialty medical drugstore.

If you want to transfer from one pharmacy to GoGoMeds, just provide the name and phone number of the pharmacy when you process your order. Upon fulfillment, your medicine can be shipped to you directly or delivered according to your instructions.

6. Alto Pharmacy

Alto Pharmacy fills your prescription and delivers your meds for free. The pharmacy stocks all common medication and specialty treatments and sells them to you at the best price. With the same copay and free delivery, you’re sure to achieve medicine cost savings.

With the acquisition of Round Health, Alto Pharmacy helps ensure people actually take their medicine. The reminder app not only takes note of your schedule for taking your medication but also the patterns and rhythms of your life. This allows the app to remind you of your medication more effectively.

You also have the option to have your prescription refilled at a specific schedule and right on time.

7. NimbleRx

Fast and reliable medication dispensing is what NimbleRx is all about. They offer fast delivered pharmacy services that ensure patients get their prescription on time.

Delivery is always free, and you get to choose when and where you want to receive your prescription. Just have your doctor send your prescription directly to the pharmacy and they will take care of the rest.

If you need to manage your refills, just use the Nimble Pharmacy app. It’s easy to manage and will speed up purchase and delivery services.

8. MedAvail

MedAvail has created medication pick up points, self-serve pharmacy kiosks where patients can pick up their prescriptions and over-the-counter medications.

The MedCenter, as the kiosk is called, is remotely controlled by a pharmacist who interacts with clients through audio and video network connection. Think of it as an ATM that dispenses medication on the spot instead of notes.

You can choose from over 500 medications through this 24-hour, on-the-spot pharmacy.

9. GoodRx

With the outrageous costs of drug prices, pharmacy start-ups that offer medication cost savings will save patients from financial worries. GoodRx is one of the drug coupon companies that provides patients with information as to where they can buy the prescription medication for the lowest price.

Using coupons, clients can save so much more.

Through GoodRx, you can compare drug prices from over 60,000 pharmacies in the US, print free coupons, and save up to 80% on your medication. You can also save a copy of the coupon on your phone and show it to partner pharmacies.

10. Capsule

With Capsule, your prescription can be filled right from the doctor’s office. Just tell your doctor that your pharmacy is Capsule and wait for a text with a checkout link. Here, you can place your order and schedule same-day delivery.

You can go home right after your checkup and then wait for your prescription to be delivered right at your doorstep.

But their pharmaceutical services don’t stop there. You have the option to transfer a refill from your old pharmacy, have capsule take care of your refills, and ask questions related to your prescription.

 

Sources:

https://www.reddit.com/r/buzzfeedbot/comments/8za2wk/10_pharmacy_startups_that_could_be_ma_targets/

http://www.thedigitalapothecary.com/pharmacy-innovation-news/2017/9/5/the-start-ups-disrupting-the-pharmacy-sector