A variety of public and private sector forces have had a dramatic impact on the practice of pain management in the past few years and will likely shape it for decades to come. These include measures put in place at both the state and federal level to address the opioid epidemic, ranging from e-prescribing mandates to scheduling changes and reporting requirements.
Increased scrutiny is also coming from payers as part of quality, cost control, and utilization management programs. Few physicians would argue that increased regulation was not needed in this area given the current opioid crisis; however, patients with legitimate, severe pain may be helped by a strictly controlled treatment plan that may include opioids.
Physicians treating these individuals must maintain a difficult balancing act of serving the best interest and safety of these patients while also navigating the state and federal regulations.
The growing role of specialty pharmacists in pain management
As prescribing these therapies becomes more difficult, some physicians have found value in leveraging their relationship with specialty pharmacies, especially as they manage patients on high-risk, high-cost, or otherwise complex medications.
Pharmacists at large specialty pharmacies not only work with physicians and patients across the country, but must also maintain careful compliance with each state’s unique prescribing, reporting, and tracking regulations. At the same time, these pharmacists maintain clinical calls to patients, so unlike retail pharmacists, they are in a position to help physicians monitor patients and red-flag any concerns about misuse or diversion.
As a result of this high-touch model and inherent regulatory expertise, specialty pharmacists are playing a greater role as an important resource for physicians looking to preserve the time they spend on direct patient care.
Dealing with the administrative burdens associated with prescribing
Practices are also burdened by complex prior authorization requirements put in place by payers for certain pain management therapies. To address this issue, pharmacy staff may be willing to step in to reduce the amount of paperwork associated with this process. In the case of newly-approved therapies, physicians may also tap into pharmacy staff to ensure that the patient can actually afford these often high-cost medications. This may include connecting patients with financial assistance programs put in place by drug manufacturers in order to offset these costs.
“At my clinic, we’re doing much more than prescribing and procedures,” explains Dr. Matthew Kaplan, DO, founder of Preferred Pain and Spine in Texas. "We’re also counseling the patient, gaining their trust and helping them understand why we won’t increase dosages or switch medications. I’ve found that specialty pharmacies can take some of the administrative burdens associated with prescribing off of my shoulders, so that I can focus on these important activities.”
New technologies connect physicians and pharmacists
Some pharmacies are also offering physicians new ways to streamline prescribing through advanced technology. These include adherence text messaging programs for patients and mobile apps for physicians designed to provide manufacturer-agnostic information about pain management therapies, among others.
Practices are also demanding greater information and reporting from these pharmacies, which are in a position to collect and share important data about each patient’s medication adherence, refill rates, and response to treatment. These data can help guide the long-term treatment for pain management patients, especially for individuals on higher-risk drugs such as opioids.
Emerging therapies offer alternatives to older opioids
Specialty pharmacies are also in the pain management spotlight for another reason. The FDA has recently approved a variety of alternatives to opioids, as well as opioids with greater abuse-deterrent properties. Many of these therapies are higher cost and may require risk evaluation and mitigation strategies (REMS).
REMS programs, driven by the FDA have rigorous requirements for reporting, patient monitoring, and education. As a result, many manufacturers are distributing these medications through a more tightly controlled network of large specialty pharmacies.
A future where greater collaboration is key
As the practice of pain management becomes even more complex and specialized, it stands to reason that specialty pharmacies must position themselves as a resource for physicians looking to safeguard their practice while ensuring that patients receiving higher-risk therapies are adherent to treatment. The burdens associated with monitoring patients, safeguarding treatment decisions, and addressing potential misuse and diversion cannot and should not be shouldered by physicians alone.
Most importantly, by strengthening the relationship between clinician and pharmacist, the health care industry can ensure that patients are receiving the safest, most effective and appropriate treatments available while protecting health care providers.
About the Author
Eric Sredzinski, PharmD, executive vice president for clinical affairs and quality assurance pharmacy program director at Avella Specialty Pharmacy.