Improving Access to Provider-Owned Specialty Pharmacies
Building the case for patients to receive specialty medications directly through their healthcare provider.
The Challenge
A physician-owned or health-system specialty pharmacy wanted to fill prescriptions for its own patients. However, certain insurance plans required patients to use outside mail-order specialty pharmacies.
That separation could cause:
- Delays in starting treatment.
- Poor communication between the pharmacy and physician.
- Medication shipments after treatment had changed.
- Wasted high-cost medications.
- A more confusing experience for patients.
- Lost revenue for the provider-owned pharmacy.
The Consulting Approach
The Pharmacists Care Team helped develop a value-based case for allowing qualified provider-owned pharmacies into payer networks.
The strategy emphasized that an integrated pharmacy may:
- Access relevant medical information.
- Coordinate directly with the prescribing physician.
- Respond quickly when treatment changes.
- Prevent unnecessary medication shipments.
- Start patients on therapy sooner.
- Provide closer follow-up and support.
The work also involved identifying accredited provider-owned pharmacies and demonstrating how integrated care could reduce waste and improve treatment coordination.
The Potential Impact
Allowing patients to use a provider-owned specialty pharmacy can:
- Improve medication access.
- Reduce treatment delays.
- Prevent unnecessary dispensing.
- Strengthen communication among the care team.
- Reduce waste involving expensive medications.
- Improve the patient experience.
Services Featured
Specialty Pharmacy Strategy · Payer Relations · Medication Access · Integrated Care