Key Market Trends Shaping Health Systems and Specialty Pharmacies

The rapid growth of the specialty medication market presents both exciting opportunities and new challenges for health systems, pharmacies, and patients. As price increases, an aging population, and a surge of innovative therapies continue to reshape the landscape, health systems are increasingly integrating specialty pharmacy care to improve patient outcomes and manage rising costs. The key market dynamics driving the evolution of in-house specialty pharmacies, strategies health systems can use to navigate these changes, and the critical role of insurers and pharmacy benefit managers (PBMs) in ensuring patient access to new treatments are all shaping the future of specialty pharmacy. As this sector continues to play a pivotal role in healthcare, understanding these trends is essential for navigating the evolving landscape of patient care.

4 Key Market Dynamics Shaping the Future of In-House Specialty Pharmacies

The specialty medication market has seen rapid growth over the last decade, and it’s set to continue for at least the next five years. Health systems, pharmacies, and patients will face new challenges, such as price increases, an aging population, and the influx of innovative therapies. These factors are expanding the specialty medication pool and shifting market dynamics.

As a result, health systems are increasingly focusing on integrating specialty pharmacy care within their hospitals. This integration helps improve patient outcomes and experiences. By 2028, health system-owned specialty pharmacy programs are expected to capture over 25% of the market, offering a more efficient and effective care model.

Many large health systems have a strong advantage due to their in-house specialty pharmacy programs. These programs have become crucial to their growth strategies. Over 95% of large health systems now operate their own in-house specialty pharmacy, allowing them to better respond to market changes.

Looking ahead, these in-house specialty pharmacy programs will be essential for tackling evolving market dynamics. They enable health systems to improve patient outcomes, reduce total care costs, and support further expansion. From 2025 and beyond, health system leaders will rely on these programs to navigate the complex healthcare landscape.

3 Key Strategies Health Systems Can Use to Navigate Shifting Specialty Pharmacy Dynamics

Since 2019, the market for specialty medications has seen significant growth, with over 200 new drugs entering through limited distribution drug (LDD) networks. This marks a nearly 20% increase from the previous five years. Health systems are primarily responsible for delivering care for these medications, making integrated specialty pharmacy programs crucial for managing these patient populations.

In recent years, changes to the 340B program have added complexity to the specialty pharmacy landscape. The 340B program offers discounted drugs to hospitals that serve underserved populations. However, several drug manufacturers have imposed restrictions on how these discounted medications can be distributed. This has limited the ability of contract pharmacies to play a role in distributing 340B drugs.

Health systems with in-house specialty pharmacies can effectively address these new challenges. By bringing prescriptions back into their facilities, health systems can bypass the restrictions and provide improved care to patients. This strategy also helps health systems maximize the use of 340B resources, ensuring that more savings are reinvested into patient care.

Looking forward, health systems are increasingly focusing on enhancing their onsite specialty pharmacy programs. By doing so, they can navigate shifting market dynamics and ensure better outcomes for patients. With these integrated programs, health systems can meet rising demand, manage costs, and provide quality care more efficiently.

How Integrated Health Systems Can Enhance Access to New Treatments

Why Insurers and PBMs Are Crucial to the Healthcare Ecosystem

As the specialty pharmacy sector grows, more insurers and pharmacy benefit managers (PBMs) partner with health systems. PBMs act as intermediaries between insurers and drug manufacturers to manage prescription drug benefits. This trend will continue, aiming to improve patient outcomes and reduce costs for all parties involved.

These partnerships offer several benefits, especially as the number of specialty patients and the cost of their medications rise. By collaborating with health system pharmacies, insurers and PBMs provide personalized patient support, including medication adherence programs, care coordination, and insurance coverage navigation. These efforts help improve therapy effectiveness and manage high costs.

Health systems leverage these new partnership models to their advantage. As specialty pharmacies gain influence in healthcare discussions, health systems provide value by focusing on emerging therapies and evolving regulations. The future of integrated specialty pharmacies looks promising, with increased access to care and treatment, as well as cost-saving opportunities for both providers and patients.

Author

Bernice Lottering