Drug Topics - January 14, 2008 - (Page 23) 23 which are centered around clinical issues, billing issues, and the ability to gather outcomes information with regard to the use of these drugs. The independents did a great job managing these drugs and building these companies, but were eventually bought out by regional companies and then inevitably by the PBMs. “I don’t think it is too late for community pharmacies to get back in this market, but there is a lot of angst in the marketplace, not only with pharmacies, but also within the pharmaceutical industry. I’ve also talked with a number of payers that are very uncomfortable with the way they’re being held hostage by the PBM industry.” Dennis Burton, VP of specialty pharmacy services at SpecialtyScripts Pharmacy, Fall River, Mass., also believes PBMs are funneling much of the specialty pharmacy business to their own operations. He lists six dominant PBM- controlled specialty pharDT CAPSULE macies: Aetna, Cigna, Anthem’s PrecisionRx, Medco, Express Scripts, and Caremark. However, Dan Steiber, R.Ph., a partner with VCG & Associates, a pharmaceutical consulting and outsourcing firm in Plano, Texas, has a slightly different take on the specialty pharmacy/community pharmacy market. The reason many community pharmacies are unable to gain access to these therapies is more due to the fact that they have not evolved to manage the drugs and the patients on them than PBM market domination, Payers don’t want to be locked into using PBM-owned specialty pharmacies. How this independent succeeded in specialty pharmacy I ndependent specialty pharmacy success stories are beginning to spring up all over the country. One example is Diplomat Specialty Pharmacy in Flint, Mich., which just opened its fifth location. According to president and CEO Phil Hagerman, R.Ph., Diplomat is one of the largest compounding pharmacies in the United States. A few years ago Hagerman recognized that his customers needed a reliable source for specialty pharmacy, and with his compounding expertise, “embraced specialty pharmacy as a natural extension of our professional practice,” he said. Diplomat has since expanded into four additional markets, including Grand Rapids, Mich.; Chicago; Fort Lauderdale, Fla.; and Cleveland, Ohio. The privately held company focuses on oncology, HIV/AIDS, hepatitis C, multiple sclerosis, rheumatoid arthritis and psoriasis. Other specialty areas include transplant, fertility, dialysis medication management, bio-identical hormone replacement therapy, and specialty compounding. The company’s health services division, launched in 2006, specializes in disease man- agement programs for home and outpatient infusion therapy patients and chronic kidney disease (CKD) patients. Between 1993 and 2005, Diplomat averaged a Phil Hagerman 20% growth rate, of Diplomat which “came from pharmacy owns taking care of five locations doctors, one doctor at a time and one patient at a time. When we started this aggressive, nationwide expansion plan in 2001, we started putting the pieces in place and actually grew more than 100% in the last two years,” Hagerman said. In the late 1990s, Diplomat moved from a traditional frontend retail store to a professional medical setting. By the end of 2000, people in the community began to view Diplomat as a medical partner rather than as a store that filled prescriptions. That change set the stage for Diplomat to make the leap nationally. Each step along the way, Hagerman brought in experts to help manage the growth into new markets. “We brought in a nationally known chain pharmacy executive to run our purchasing and finance department, a hospital infusion expert to develop our home infusion and infusion suite business, a pharmaceutical sales executive to develop our oncology sales program, and just recently brought in a managed care executive as our VP of Managed Markets,” Hagerman said. Today Diplomat employs 220 employees, including 26 pharmacists and 16 nurses, who provide and oversee a number of patient education services. “Pharmacists historically are a pretty financially conservative and a little slow and unwilling to get out of the box and spend money before they know it’s going to pay,” said Hagerman. “My advice to independents – look for the physicians who are willing to partner with you because that will make the difference between them just sending you a few patients and you being able to create and manage successful programs with them.”
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