How Health Systems Can Meet the Expanding Needs of Specialty Pharmacies

Lindsey DeMarrais, Managing Pharmacist Consultant, McKesson

An increasing number of patients in the US rely on specialty medications, but many health systems are struggling to keep up with growing demand. These complex therapies, which require special handling and administration, as well as multiple pharmacy touchpoints, were being used by nearly 6% of the population in 2023, up from 5.3% just a few years earlier. Manufacturers are, in part, contributing to the rapid growth of the specialty pharmacy market, with specialty drugs making up about 70% of the medications on the docket for FDA approval in the next 5 years.

The prevalence of specialty pharmacies within health systems has increased tremendously in recent years, with up to 90% of large hospitals and health systems operating a specialty pharmacy. With market growth and population usage expected to continue on this upward trajectory, scaling services and developing a more robust, higher-maturity specialty pharmacy program while maintaining quality care is crucial.

Why Specialty Pharmacies Matter for Health Systems

Specialty pharmacies are critical in improving medication adherence, advancing patient outcomes, and expanding access to life-saving specialty therapies. Health systems that integrate these pharmacies into their care networks report better outcomes for patients and increased provider satisfaction, with 95% of providers agreeing that integration saves clinic staff time and improves communication during medication access and treatment processes.

These operations also reduce care fragmentation by retaining prescriptions and patient care within the health system network. Health systems with mature specialty pharmacy programs experience higher prescription capture rates, driving financial sustainability for health systems and better outcomes for patients.

Additionally, specialty pharmacies alleviate administrative burdens by handling prior authorizations, patient onboarding, and financial assistance. In fact, provider satisfaction scores for integrated specialty pharmacies, as measured on a 5-point scale, average 4.72 compared to 2.97 for external models—making integrated pharmacies’ scores 59% higher than external models.

Strategies for Expanding Specialty Pharmacy Services

According to in-depth interviews conducted by McKesson with more than 100 US-based health system and specialty pharmacy leaders, the ability of health systems to successfully integrate specialty pharmacy services largely depends on 3 main factors: establishing a clear strategy to reduce administrative burden, embracing innovative technologies, and a willingness to collaborate with key partners.

1. Reducing Administrative Burden

Due to complex requirements that specialty pharmacies must meet, administrative tasks pose a significant burden. Leading organizations are implementing specific strategies to combat this, including centralizing prior authorization processes, creating dedicated teams for benefits investigation, and establishing standardized workflows for documentation.

Automating workflows and using tools such as payment reconciliation and revenue cycle management systems helps to streamline operations, but according to the McKesson report, only 14% of specialty pharmacies are significantly leveraging these tools, and 28% do not leverage them at all. Such strategies could free up time for pharmacists to focus on patient care.

2. Embracing Tech Innovation

Despite automation being used to some degree by all pharmacies, there is an opportunity for increased adoption to drive efficiency. Awareness is key—researching new tools and attending conferences on automation technologies can help pharmacy staff identify new approaches to enhance patient monitoring, ensure operational consistency, and streamline pharmacy scalability in addition to reducing administrative burden.

Leading organizations are also moving beyond basic automation, using integrated platforms that combine benefits verification, clinical documentation, and predictive analytics. High-maturity specialty pharmacies are piloting artificial intelligence (AI) systems that can identify patients at risk of nonadherence before problems arise, allowing for earlier interventions.

3. Collaboration with Experts

Partnering with experienced consultants or joining pharmacy service organizations can help health systems improve their specialty pharmacy programs. McKesson’s Professional & Advisory Services (P&AS) team, for example, has helped health systems access limited distribution drugs (LDDs), manage payer requirements, and simplify workflows. Outside expertise can also help navigate policy changes.

External expertise plays a crucial role in specialty pharmacy development. Consultants help health systems navigate complex requirements for LDDs, develop workflows for new therapy areas, and implement best practices from across the industry.

Benefits for Patients and Providers

Beyond simply dispensing medication, specialty pharmacies support patients by providing education, managing side effects, and addressing access and financial barriers. With 83% of specialty pharmacies measuring financial savings for patients, systems that automate financial assistance processes during adjudication improve access and adherence.

For example, specialty pharmacies often help patients navigate financial barriers by connecting them with copay assistance programs, manufacturer support, and foundation grants. They also streamline prior authorizations to prevent delays in treatment. These efforts can reduce stress for patients, improve their ability to adhere to medication regimens, and ultimately improve outcomes.

Patients benefit when specialty pharmacies focus on their specific needs. This includes managing medication side effects and coordinating care between pharmacists and other providers. Patients who feel supported are more likely to stay on their medications, leading to better health outcomes.

Specialty pharmacies can streamline medication access by coordinating between providers, payers, and manufacturers. They advance care equity through comprehensive financial assistance programs and multilingual patient support. Perhaps most importantly, they can provide consistent monitoring and support throughout treatment, helping identify and address barriers to medication adherence before they impact outcomes.

Providers also benefit from an effective pharmacy network. Integrated specialty pharmacies reduce administrative burdens on clinics, allowing health care teams to focus on patient care. They improve communication between care teams and help ensure patients have access to the treatments they need.

Addressing Policy and Access Challenges

Regulatory changes can present significant hurdles for specialty pharmacies. Hospitals and health systems can mitigate these challenges by staying informed, developing contingency plans, and collaborating with external experts.

The McKesson study found that high-maturity pharmacies were twice as likely as medium-maturity systems to have strategies in place for managing 340B and direct and indirect renumeration (DIR) reforms. Investing in policy awareness and proactive planning can protect against financial and operational disruptions.

Policy changes and payer requirements can also create hurdles for specialty pharmacies. LDD agreements, changes in reimbursement policies, and stricter prior authorization processes can complicate operations. High-performing specialty pharmacies address these challenges by staying informed, developing contingency plans, and collaborating with external experts.

Health systems can also address these challenges by hiring staff with expertise in navigating policy changes or by working with external consultants. Investing in policy awareness and proactive planning can protect against financial and operational disruptions and allow pharmacies to continue to meet the needs of their patients.

The Road Ahead for Specialty Pharmacies

With specialty pharmacies projected to experience a 5% compound annual growth rate over the next few years, driven in part by increasing demand for high-cost therapies, the pressure on health systems to scale their specialty pharmacy services has never been greater. Optimizing these services is not just an operational imperative but a critical component of improving outcomes for patients and providers alike.

Health systems must evolve their specialty pharmacies to address rising demand, technological advancements, and shifting policies. By focusing on patient care, adopting innovative technologies, and partnering with experts to optimize their specialty pharmacies, health systems can thrive in an increasingly competitive landscape.

References

Lonergan M, Rayburg R, Gregg R, et al. 2024 Artemetrx state of specialty spend and trend report. Published June 11, 2024. Accessed January 3, 2025. link.psgconsults.com/2024-spend-and-trend-report

Myers B. Expert Q&A: Expanding the specialty pharmacy to boost your health system’s revenue. McKesson. Accessed January 3, 2024. https://www.mckesson.com/pharmacy-management/health-systems/prescribed-perspectives/expert-qa-expanding-the-specialty-pharmacy-to-achieve-more/

Pedersen CA, Schneider PJ, Ganio MC, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: Prescribing and transcribing—2019. Am J Health Syst Pharm. 2020;77(13):1026-1050. doi:10.1093/ajhp/zxaa104

Anguiano RH, Zuckerman AD, Hall E, et al. Comparison of provider satisfaction with specialty pharmacy services in integrated health-system and external practice models: A multisite survey. Am J Health Syst Pharm. 2021;78(11):962-971. doi:10.1093/ajhp/zxab079

McKesson Health Systems. Health systems specialty pharmacy research report. 2024. Accessed January 3, 2025. https://www.mckesson.com/pharmacy-management/health-systems/prescribed-perspectives/the-future-outlook-of-specialty-pharmacy/