Leah E. Perry is a healthcare writer based in the Atlanta area.

Leah E. Perry

One of the best-known drugs going generic this year is the cholesterol-lowering drug Lipitor (atorvastatin), which brought in an estimated $5.3 billion in U.S. sales in 2010. The cost of Lipitor is expected to drop from an average cost of $228 per prescription to $46 per prescription in its generic form. It is slated to go generic in November.  

Zyprexa (olanzapine), Eli Lilly's top-selling drug, prescribed for the treatment of schizophrenia and bipolar disorder, is expected to drop from $747 per prescription to $149, once it goes generic in October. 

The following is a partial list of other notable blockbusters that either have already gone off patent or are in the pipeline and expected to do so by the end of 2014:  

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As a flurry of blockbuster drugs lose their 20-year patent protection, the market is splitting wide open as drugmakers offer competing generic versions.

Floodgates open

In an effort to improve technology and security in its pharmacy operations, Ashtabula County Medical Center in Ohio recently began using QuadraMed's Pharmacy Integrated Medication Management (IMM) system. 

The IMM system provides real-time wireless and point-of-care medication scanning. It also allows nurses to verify a patient's identity, validate medications against active orders, and document medication administration online. The technology is designed to reduce medication errors and improve overall patient care. 

A key selling point for Ashtabula was "definitely the integration piece," according to Wendy Nagy, RPh, a staff pharmacist and clinical coordinator at Ashtabula. IMM "has the nursing component along with the electronic medication administration record (MAR), physician order entry, and an electronic medical record," she said. The facility is hoping to implement all the components eventually, providing a single fully integrated solution.  Ashtabula went live with the pharmacy component in May, replacing a much older Cerner system. So far, the biggest advantage Nagy has experienced is reduced paper in the pharmacy. "There is definitely less paper involved and less duplicate stickers. We are able to record electronically who checks the identifications," she said. "Our goal is to eventually go to bar-code medicine and online MARs." 

Once fully implemented, the unified database will provide seamless medication management and close the loop from order entry to medication administration. Nursing and pharmacy staff will gain instant access to patient status records and clinical information, which will further assist in reducing medication administration errors and streamlining workflow. 

Ashtabula is the first pharmacy to implement the system since QuadraMed purchased it from Misys in 2007. Once the purchase was complete, QuadraMed immediately began working on product enhancements. At that time, October 2007, Ashtabula was already in the beginning stages of implementation. The implementation team then worked for another eight months to get the facility ready to meet its live deadline. 

"Because the system is a total pharmacy system, the pharmacists played a pivotal primary role in the whole process, because they are the gatekeepers for the medication dispensing process and for patient safety," Carol Boehmer, QuadraMed's manager of client services and Ashtabula's IMM project manager, said.  

"The entire implementation was accomplished by the director of pharmacy, the pharmacists, and pharmacy techs. Vendor and hospital had to work together to meet the Ohio State Board of Pharmacy IT requirements - some of the strictest in the nation. Many of the requirements were new and unfamiliar to the staff. Among the mandates was a requirement for a specific sign-on to identify the staff member entering the orders and performing the key strokes.  

To meet that criterion, QuadraMed collaborated with a third-party vendor (Maxim Integrated Products), which manufactures plastic keys, called iButtons, that enhance system security.   This security measure ensures that the person interacting with the application and entering the orders is the person to whom the unique log-on and password have been assigned. If the key is removed from the computer without proper log-on or log-off procedures, the application shuts down immediately.  

Although a fairly smooth implementation was accomplished, there were some challenges along the way, particularly working with a small IT department and a pharmacy staff that had to continue with daily operational responsibilities while performing a major IT system overhaul.  

An Ohio hospital automates its pharmacy with an integrated medication management database.

Medication management goes electronic at an Ohio hospital pharmacy

These predictions were made by Accredo Health Group VP of Health Outcomes Solutions Richard Faris, Ph.D., R.Ph., in August at the National Association of Chain Drug Stores Pharmacy and Technology conference in Boston. Accredo is a specialty pharmacy services provider based in Memphis. Faris' comments and similar market forecasts have been the catalyst for community pharmacies to start reaching beyond their comfortable borders to grab a share of the growing specialty pharmacy market. 

More and more, community pharmacies are facing either joining a specialty pharmacy network or being shut out of access to many drugs considered specialty meds with restricted distribution. Bruce Roberts, R.Ph., executive VP and CEO of the National Community Pharmacists Association in Alexandria, Va., for one, is not pleased about the present state of specialty pharmacy as it relates to community pharmacists.  

Specialty players started out of the independent marketplace, Roberts continued. "Independents saw this as an opportunity to address the needs of specialty drugs, 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. 

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 pharmacies: Aetna, Cigna, Anthem's PrecisionRx, Medco, Express Scripts, and Caremark. 

Some believe it's not too late for community pharmacies to get into this field, which is growing by leaps and bounds.

Specialty Pharmacy: Don't miss the boat

Currently in development for retail pharmacies is the Community Specialty Pharmacy Network (CSPN), based in Philadelphia. The proposed 100-store network is designed to serve as a resource and support system to assist community pharmacies in expanding and building on their specialty pharmacy business. 

But for many of Gellis' colleagues across the country, the process of providing specialty pharmacy services is something new-and very different from the specialty pharmacy environment of a few years ago. The root of this surge of interest in specialty pharmacy by community pharmacists is threefold: a trend by payers looking to diversify, the opportunity to provide specialty services to small pharmacy benefit managers that don't have mail order or specialty pharmacy, and big changes in reimbursement.  

However, what has been a springboard to action for some community pharmacies has been an obstacle for others. The reimbursement environment has proven to be a bit dicey for independent pharmacists looking to segue into specialty pharmacy, said sources who spoke to 

"The biggest obstacle [independent pharmacists] have is on the reimbursement side," said Dean Erhardt, a partner in and general manager of biotechnology services for the pharmaceutical consulting firm VCG & Associates, St. Louis. "What has been going on in the specialty pharmacy and PBM world in the past few years is that the contracting at the payer level goes to PBM mail order or specialty pharmacy mail order and away from retail pharmacy," he explained. He and other VCG consultants worked with NACDS in developing the specialty pharmacy white paper. "So, the first thing the retailer has to do is get back in the game by having a relationship with both the payer community and the manufacturing community." 

According to Erhardt, manufacturers can help independents identify the services they should make available for therapies at the payer level. "What we hear when we talk to payers is not that they are opposed to retail, but that when they're talking about how to set up a distribution program, retail is not even at the table," he noted. 

Community pharmacies have been bypassed because specialty pharmacies have gone to the payers and allowed them to access these very specialized medications at a better price, Erhardt continued. 

Independent pharmacist John Musil, Pharm.D., of Phoenix, agreed with Erhardt's view of the current landscape but added that it is often difficult for independents to break into existing networks and acquire a share of the specialty pharmaceutical business. "A lot of independent pharmacies have trouble developing good manufacturer relations," he said. "It's been an issue for pharmacists to communicate well because they see manufacturers as evil, when, in fact, they can be their best friend."  

An increasing number of community pharmacies are venturing into the specialty pharmacy arena. Despite what some industry experts describe as a fragmented marketplace, community pharmacy leaders say they are poised to take on and develop this segment of the industry and keep specialty drugs in their settings.