Q&A: How Specialty Pharmacies Are Evolving Into Disease Management Hubs

For decades, the specialty pharmacy's core value proposition was straightforward: get a complex, high-cost medication into the hands of the right patient at the right time. That mission remains essential, but as the financial and clinical stakes of specialty therapeutics escalate, a growing number of health system specialty pharmacies are pushing past the dispense model, positioning themselves as longitudinal care partners embedded in the clinical workflow.

Specialty drugs now account for roughly 50% of total pharmacy spend despite being used by only about 2% of patients, a concentration of cost and complexity that is placing new demands on everyone in the care continuum.¹ Additionally, the specialty pharmaceuticals market grew from $92.5 billion in 2023 to $129.2 billion in 2024, and is projected to approach $965.5 billion by 2030, which is a compound annual growth rate of 39.8%.² Against that backdrop, the question facing health system specialty pharmacies is no longer simply whether they can fill a script accurately and quickly. It is whether they can demonstrate measurable, repeatable clinical value that justifies their role in an increasingly outcomes-driven healthcare environment.

The operational and clinical answer to that question is taking shape in the form of expanded care management programs that layer adherence coaching, lifestyle counseling, social determinants of health (SDOH) screening, and chronic disease management directly onto the specialty pharmacy model. The rationale is grounded in a well-documented reality: medication adherence alone does not guarantee patient success when housing instability, nutritional deficits, or behavioral health barriers go unaddressed. Health system specialty pharmacists are uniquely positioned to identify and care for patients who may be adversely affected by SDOH, given their trusted patient relationships and working knowledge of health system navigation, and they can play a major role in referring patients to support programs, social services, and other resources.³ That proximity to the patient, which can be more frequent and more intimate than a physician visit, is increasingly being recognized as a strategic asset rather than a transactional touchpoint.

One analysis estimated that specialty therapies accounted for roughly $400 billion and 52% of net drug spend in 2025, concentrated in some of the most complex areas of care, including oncology, autoimmune diseases, neurology, and rare diseases.⁴ For health systems investing in specialty pharmacy infrastructure, those concentrations represent both risk and opportunity. When patients on high-cost biologic or oncology regimens disengage from therapy, the clinical and financial consequences ripple across the enterprise. Conversely, when a specialty pharmacy is structured to intercept those disengagement signals early—through regular touchpoints, proactive side effect management, and goal-setting between physician visits—the potential to improve both outcomes and total cost of care becomes meaningful.

Within this evolving context, Bill McElnea, vice president of population health at Shields Health Solutions, and Hinal Sharma, a diabetes clinical care coach at Shields Health Solutions, sat down with Pharmaceutical Commerce in a live Q&A to discuss what it actually looks like to build a care management platform around the specialty dispense, and what it takes to scale it. Their insights offer a ground-level view of a structural shift that is quietly but meaningfully redefining what a specialty pharmacy can be.

Access both parts of our video interview with McElnea and Sharma:

1. Asembia AXS26: Rethinking Specialty Pharmacy as a Care Management Platform
2. How Specialty Pharmacies Are Becoming a More Central Part of Patient Care

PC: How does a specialty pharmacy evolve from a drug dispenser to a care management platform?

McElnea: I think a lot of the answer to that has to do with the care model that you're building around that dispense. That's something that we've worked very closely with our health partners on, in terms of whether it's deploying a pharmacy liaison in the clinics that you're supporting to address all the pharmacy or the administrative related burden associated with specialty pharmacy scripts. We then are layering folks like Hinal (Sharma) onto that as well to make sure that the patient is staying adherent, addressing side effects, and making sure the patient is fully educated on their meds. I think we spent, as a company, probably the first six or seven years just focusing on that core model and then realized that there was more that we could do. There were other disease states we could tackle. There was more that we could tailor to it.

Sharma: I would say the biggest thing is it's not a one-size-fits-all option. We have the opportunity to really tailor our care to what each specific patient needs using a library of resources. So we've got, of course, the clinical knowledge, the medications, nutrition, and lifestyle modifications. Bring it all together, and you can collaborate right there with the clinic.

What has the impact on adherence and patient success been like after expanding services from traditional dispensing to include lifestyle counseling, SDOH support and more?

Sharma: It's been a huge improvement for sure. I would say the best way to compare it to is, in a traditional model, you're getting a lot of counseling around medications, and of course, we're all well-equipped to counsel on lifestyle modifications, but you just don't have the time that you need to really give the patient what they need. In a program like this, you can meet with them weekly, set small incremental goals, and really help them. I guess a good way to explain it is you go to an appointment with your doctor. You see them every three to six months. you leave that appointment with a library of things that you need to be working on, and it's a long list. You lose that motivation. There's a lot to do. So we can break it down step by step, week to week, and you don't always have the opportunity to be able to do that when you're in a traditional specialty pharmacy model.

McElnea: I think another thing we've observed through the Care Coach program is that there's a certain cohort of patients that are dealing with so much, and that it's the social determinants of health that are the primary barrier. If you don't get over that, the normal Amcare pharmacist services just aren't going to have that impact. And that's one thing that Hinal (Sharma) and the team have done a great job of, is screening for that, because obviously, if someone is on the precipice of getting evicted from their house, they're going to be a lot less likely to remain adherent to their medication. So knowing when those things are coming up and having the tools to refer to the right types of resources is really critical.

How can specialty pharmacies scale these "high-touch" models to help more patients?

McElnea: The short answer to that is gradually. It's definitely something that doesn't happen overnight. I think one thing that's really important for health system specialty pharmacies is to make sure that you're really getting those core competencies in core pharmacy set, because you will inevitably see, comorbidities come in that are outside the traditional specialty scope, like diabetes and like COPD. You'll develop your skillsets servicing those as a comorbidity, and as time goes on, you'll be prepared to address patients that have that as a leading disease state. As you dive deeper with clinics, you realize that there's always going to be those cohorts of patients that need a lot more of that in-between appointment support, and that's where we have found the bridge from traditional specialty pharmacy to chronic disease management, and that specialty pharmacist skillsets, it turns out, are really well-positioned to provide effective chronic disease management.

In 5 years, will specialty pharmacies be viewed as vendors or more as a primary hub in patient care?

Sharma: I'm leaning towards primary hub. The reason I say that is you can bring things together from all aspects of the patient's medical care, almost acting as that one patient advocate within an entire clinic. So when you have the pharmacy and the clinic and then you have your one person that you can go to for all of your answers that's easily accessible, you end up becoming that hub and you're passing on the advice and re-encouraging them to follow recommendations provided by their entire clinical care team.

McElnea: We're already seeing that expansion of specialty pharmacies that are moving more into retail because they want to be that one-stop pharmacy resource for patients. To do that, they are having to fill not just specialty medications, but also maintenance medications, durable medical equipment and so on. That is increasingly making them that central hub, and it also makes them, at a minimum, a really valuable population health tool for the population health teams and managed care teams to leverage more and more to drive savings and drive incremental pharmacy revenue. There's a lot of wins that come out of merging those two worlds.

References

1. Caffiero NA. AMCP 2026 spotlights new era for specialty drug market. AJMC. June 2026. https://www.ajmc.com/view/amcp-2026-spotlights-new-era-for-specialty-drug-market
2. Trilliant Health. 2026 Specialty Pharmacy Market Report. 2026. https://www.trillianthealth.com/2026-specialty-pharmacy-market-report
3. Hopkins G. Pharmacy Times. Specialty pharmacists can help identify, alleviate 5 SDOH categories. April 2026. https://www.pharmacytimes.com/view/specialty-pharmacists-can-help-identify-alleviate-5-sdoh-categories
4. Shields Health Solutions. Benchmarking the Future: Industry-Leading Specialty Pharmacy Outcomes. March 2026. https://shieldshealthsolutions.com/specialty-pharmacy-clinical-outcomes-report/