May 14, 2011 
People with complex conditions such as RA, cancer, hemophilia, MS, HepC, and other diseases that are treated with specialty drugs (often injectibles) are subject to several unique complexities in filling their prescriptions:
- Potentially significant cost burdens
- Limited locations at which to fill their medications
- Prior authorization requirements
- Scheduling complexities for delivery or home infusion or coordination with their physician’s office
But, there can also be another complexity called “limited distribution” which is where the manufacturer has only allowed the drug to be filled by a select list of pharmacies. So, imagine the following situation:
- You are a patient with multiple co-morbidities.
- You have several chronic oral medications along with several specialty drugs that you have to fill.
- You fill one of your chronic medications at retail since you forgot to refill it in time one month at mail and just haven’t gone back since the saving is minimal (as it’s a generic).
- You have two other oral, chronic medications that you fill at mail order.
- You fill two of your specialty medications at the preferred specialty pharmacy under your benefit (i.e., limited network).
- You fill your last two specialty medications at two other specialty pharmacies since both of them are limited distribution products neither of which have contracts with the preferred specialty pharmacy in your network.
You now have to coordinate between five pharmacies. What ever happened to people worrying about poly-pharmacy? Is it an issue?
- In this survey from a few years ago, almost 50% of patients used more than one pharmacy.
- In this study published last year, it looked like even people that used more than one pharmacy still filled the majority of their claims at their primary pharmacy.
Now, this is important since complexity of therapy (# of drugs and # of pharmacies) appears to be a key factor influencing likelihood of adherence, but I never hear anyone worry about it anymore.
So, I ask…are the limited distribution deals which limit access to a specific specialty drug an undo burden on the patient or is the value of specialized care and monitoring more valuable to the patient?
Enabling Healthy Decisions 
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