How Specialty Pharmacies Are Redefining Their Role in the Patient Journey

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.

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

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.

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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/