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Health system specialty pharmacies dispense medications that increasingly cost nearly as much as the median U.S. home, require temperature-controlled shipping or other special handling, and demand complex prior authorizations. Often all at once. Yet these complexities (and the potential hundreds of thousands of dollars at risk if they’re mishandled) haven't deterred health systems. 

In fact, more health systems each year are bringing specialty pharmacy operations in-house, recognizing both the clinical and financial benefits of directly managing these critical services. Given that, it makes sense that health systems are partnering with tech platforms and specialty experts to get it right.

Why specialty pharmacy is moving in-house

With all these potential challenges, it seems counterintuitive for a health system to invest in their in-house specialty pharmacy versus outsourcing to established players. However, integrated health system specialty pharmacies (HSSPs) afford a greater level of continuity of care, allowing the pharmacist to be an active member of the care team. Additionally, HSSPs have demonstrated superior medication adherence rates as well as more proactive management of adverse side effects, leading to fewer discontinuations.

Beyond the patient experience, moving in-house helps the bottom line. This allows health systems to capture more of the disproportionately large growth in specialty drug spending. Additionally, moving in-house increases the capture rate for the 340B program, helping to maximize revenue for this financially crucial line-of-business.

How do specialty pharmacy enablement solutions help?

Modern specialty pharmacy requires orchestrating complex clinical, operational, and financial processes. Speciality pharmacy enablement solutions tackle these challenges across several critical areas:

Workflow Coordination: At the heart of specialty pharmacy operations is the need to coordinate multiple stakeholders. Modern platforms create digital bridges between providers, patients, and payers. Care teams can collaborate in real-time, track interventions, and ensure nothing falls through the cracks in complex treatment protocols.

Clinical Analytics & Management: Leading platforms integrate deeply with clinical systems (tracking adherence, flagging potential issues, and enabling proactive interventions), specialty medication data, and manufacturer networks. This creates a single source of truth for program performance, and enables advanced risk stratification to help pharmacy teams prioritize high-need patients. Meanwhile automated risk evaluation and mitigation strategy (REMS) tools ensure proper medication usage and documentation.

Financial Performance: These platforms tackle historically manual processes like prior authorizations and billing workflows through automation. They also provide tools to optimize revenue cycle management and maintain crucial accreditations through built-in compliance tracking and documentation.

Specialty pharmacy enablement vendor landscape

The specialty pharmacy solutions landscape primarily segments into two core categories:. 

First are the full-stack integrated service providers. These vendors offer comprehensive solutions beyond software, encompassing robust services, embedded personnel, and occasionally shared financial risk. Their appeal lies in quickly establishing specialized pharmacy programs, providing expertise, staff training, payer contracting assistance, and support for accreditation. Shields Health Solutions is the clear leader in this space, with over 80 health system partnerships and recognized as the pioneer of the integrator model.

The second category comprises dedicated software platform solutions. These cater to health systems preferring internal management of their pharmacies but requiring powerful, reliable technology platforms. Notable solutions include Keycentrix’s Newleaf, CPS’s TherigySTM, and newer entrants such as Clearway Health. There’s also House Rx which focuses primarily on large specialty practices, but could be well-positioned to handle health systems with cancer centers or large infusion center footprints.

Health systems with minimal existing specialty infrastructure or prioritizing rapid program establishment typically gravitate toward integrated partners, leveraging their turnkey solutions and established payer relationships. Conversely, those with robust internal pharmacy capabilities aiming to maximize revenue retention often prefer a software-driven approach, utilizing top-tier platforms to support internally-developed workflows.

Encouragingly, the market’s maturity has narrowed the historical knowledge and implementation gap. Today, even purely software-focused purchases frequently come bundled with substantial vendor or consultant support. However, health systems must carefully evaluate their priorities, balancing external expertise and convenience against internal control and revenue potential.