The demand for specialty medications is on the rise in the United States as people living with complex health conditions increasingly rely on new treatments and therapies to manage their health. By partnering with an advisory service, health systems can take advantage of established expertise to evaluate and choose from among the breadth and complexity of potential solutions for operating and optimizing an integrated specialty pharmacy.
Specialty drug therapies were being used by nearly 6% of the population in 2023, up from 5.3% just a few years earlier. Specialty drug therapies present challenges for health systems, as specialty drugs require unique handling, e.g., temperature control and monitoring requirements, and their effectiveness relies on patients being adherent to sometimes complex treatment plans. Notwithstanding these challenges, there has been an increase in health systems investing in specialty pharmacy programs, due in large part to the patient benefits of an integrated specialty pharmacy program.
Health system specialty pharmacies have been found to improve medication access, enhance treatment plan adherence and, ultimately, support better outcomes for patients. By bringing specialty pharmacy into their portfolio, health systems can deliver high-touch support throughout a patient’s care journey. Due to their close contact with patients, integrated specialty pharmacists are uniquely positioned to address patient concerns and potential financial barriers, facilitate patient education, and coordinate between care teams, which can reduce stress for patients and improve their ability to adhere to specialty medication regimens.
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A win for patients is a win for health systems, making it clear that integrated specialty pharmacies are a crucial strategy for health systems as they aim to provide the best possible care to the patients they serve. This is why 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 in some capacity. While clearly beneficial to patients and the health system overall, operating and optimizing a specialty pharmacy presents unique challenges that hospitals and health systems should be prepared to address.
Streamlining administrative processes
Hospitals and health systems dedicate tremendous resources to obtain the highest possible quality of patient care. This focus, while important, can mean that health systems are stretched thin when it comes to administrative support. Specialty pharmacies must meet complex requirements, introducing administrative requirements that can be challenging for health systems to manage internally. To address this challenge, there are several strategies that can be employed, including the following.
- Centralizing prior authorization processes: Getting medications approved can require a significant amount of time, effort and coordination. By streamlining approvals through a centralized prior authorization process, the time and resources needed to obtain approvals could be significantly reduced. Health systems can take this a step further by establishing standardized workflows for documentation, minimizing errors and ensuring that necessary information is captured consistently.
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- Implementing the right tools: Health systems should always be on the lookout for new tools and technologies that can help them streamline and scale their specialty pharmacy operations. Some tools are well established, like revenue cycle management systems, while other tools are constantly being created and innovated, such as AI tools that can identify patients who may be at risk for non-adherence. Leading health systems are starting to move beyond basic tools and are using integrated platforms which combine clinical documentation, predictive analytics, and benefits verification to automate their specialty pharmacy operations and reduce the need for duplicate documentation.
- Developing contingency plans: The specialty pharmacy landscape is constantly evolving, with changes in regulatory policies presenting hurdles for health systems. By staying informed and developing contingency plans around potential challenges, health systems can adapt to relevant regulatory shifts with minimal impact to their operations.
Embracing collaboration
Specialty pharmacy growth can be resource intensive. To work towards optimized, sustainable growth, health systems should consider strategic partnerships and collaboration with industry experts to help fill in any gaps. Utilizing advisory services offered by distributors, joining pharmacy services administrative organizations (PSAOs), and partnering with experienced consultants are potential strategies that can help health systems improve their specialty pharmacy programs.
Health systems can collaborate with strategic partners to optimize their specialty pharmacy operations in several areas, from researching and implementing new technologies, to staying abreast of the latest regulatory shifts and recommending new strategies for patient engagement. External expertise can be a vital advantage for hospitals and health systems in navigating the complex specialty pharmacy landscape.
Driving sustainable growth
Specialty pharmacies are projected to continue rising in popularity over the next several years due to an increased demand for complex therapies driven by more frequent diagnoses of complex medical conditions. The integration of specialty pharmacies into health systems is a strategic move that supports sustainable growth and improved patient outcomes. By addressing the unique challenges of operating a specialty pharmacy, health systems can create an efficient service model that enhances patient care while positioning the health system to thrive.
Photo: bluebay2014, Getty Images
Lindsey DeMarrais, PharmD, MS, is the Managing Pharmacist Consultant with McKesson’s Professional & Advisory Services. She has over 10 years of leadership experience across multiple health systems and world-renowned academic medical centers. In her roles, Lindsey has helped develop specialty pharmacy programs to holistically care for complex patients on specialty pharmacy therapies and through population health programs. She has developed and executed strategies to grow health system specialty pharmacy P&L and created strategies for payer and LDD access. In addition, she has overseen care coordination, infusions, financial management, clinical outcomes, population health, and patient engagement programs. Lindsey also has experience with inpatient hospital pharmacy, operations and procurement, and research pharmacy. After graduating from pharmacy school at Belmont University in Nashville, TN, Lindsey earned her Master of Pharmacy Administration degree at the University of Houston. She went on to complete her Health System Pharmacy Administration residency program at Memorial Hermann in Houston TX.
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