Growing & Sustaining a Strong Specialty Pharmacy Program
A successful health system specialty pharmacy (HSSP) program delivers quick wins for patients, clinicians, and employees while strengthening the organization’s financial health. And the long-term benefits position a health system for sustained growth, stronger patient outcomes, and a competitive edge in an always-evolving market. It’s no mystery why health systems are expanding their HSSP programs in growing numbers.
Standing up an HSSP from scratch isn’t easy, and the model for success looks different for each organization. Let’s dive into what it takes to build and sustain a powerful specialty pharmacy program.
Keys to Specialty Pharmacy Success
1. Strengthen Dispensing Services & Workflows
A successful HSSP starts with a strong dispensing pharmacy operation and efficient workflows. Many health systems have an outpatient pharmacy in place, but its mere existence doesn’t mean you’re ready to grow into an HSSP. Hospital outpatient pharmacies have historically focused on providing medications for discharged patients and employees. Treated as a commodity service, these pharmacies often require foundational improvements to financial monitoring, staffing levels, and marketplace strategy to support the anticipated growth in financial contributions for an organization.
Three areas deserve attention from day one: revenue cycle integrity, data analytics and reporting, and convenient service offerings for patients.
Revenue Cycle Integrity
The pharmacy benefit revenue cycle operates very differently from the medical benefit, so the financial tools and payer contracts used elsewhere in the health system don’t translate. Pharmacy departments need their own dedicated processes for tracking and reporting profitability.
Data Analytics & Reporting
Outpatient pharmacies also tend to run on standalone software systems, which means health system finance teams have to build new expertise to understand how revenue and expenses are captured. Establishing strong financial reporting and revenue cycle practices early on pays off.
Convenient Service Offerings for Patients
Patient convenience also looks different for an HSSP. Traditional outpatient pharmacies focus on bedside delivery and on-site pickup, but specialty patients are geographically spread across an organization’s service area and may not require routine onsite services, which means HSSPs have to reach them there. That’s primarily done through mail and delivery services, which bring added considerations like logistics and cold chain shipping. These capabilities only grow more important as an HSSP scales, mirroring the home-delivery expectations patients already have from online retailers.
2. Identify the Opportunities
Building an HSSP strategy starts with asking the right questions:
- Which clinics prescribe the most specialty medications, and how many of those prescriptions are currently filled by external specialty pharmacies?
- Does your organization have a health plan, and can you fill specialty prescriptions for plan members and employees?
- How much time and staff do your clinics dedicate to prior authorization and patient assistance work?
- What limited distribution drugs and payer networks do you currently have access to?
- What service expectations, prescription volumes, and disease state variables do you have to consider when establishing medication prior authorization support?
Many organizations assume restricted payer networks and limited distribution drugs are the biggest barriers to launching an HSSP. In reality, you can likely fill more than 50% of your health system’s specialty prescriptions from day one. Capturing that open-network, open-distribution volume should be an immediate priority.
Another opportunity sits closer to home: the health system’s own employee health plan. Health system executives and the organization’s Benefits team can modify the health plan’s benefit design to encourage or require employees to fill through the HSSP. The result is better service for employees and additional business and recurring revenue, all essential to long-term HSSP sustainability.
3. Prioritize & Execute
“Without strategy, execution is aimless. Without execution, strategy is useless.” Those words come from Morris Chang, a pioneer of the semiconductor industry, but they apply just as well to building a successful HSSP program.
Strategy gets an HSSP off the drawing board. Execution is what turns it into a thriving program, and that starts with investment in people and infrastructure. Those investments pay off fast. One of the highest-leverage moves is partnering with targeted clinics to bring prior authorization in-house, which means hiring dedicated prior authorization technicians. It’s a win-win: clinic staff can focus on direct patient care (not insurance paperwork), and pharmacy benefit work can be better coordinated for patients and providers. The process also gives pharmacy a built-in touchpoint to introduce its services and capture specialty prescriptions that might otherwise be filled elsewhere.
Beyond core retail pharmacy operations, an HSSP also needs strong call center capabilities and clinically skilled pharmacists. As capture rate grows, both should scale alongside it to keep pace with patient and clinician demand.
4. Overcome Growing Pains
Building an HSSP isn’t easy. In a volatile marketplace where HSSPs compete directly with national giants like CVS, Cigna, and Optum, success isn’t possible without the support of the larger health system.
The most successful HSSPs have strong endorsement from senior leadership and medical staff, along with active working relationships across legal, informatics, compliance, government affairs, and public relations. That kind of broad internal alignment is what helps an HSSP push through growing pains and stay nimble in a competitive market.
Where Visante Comes In: Building HSSPs Built to Last
Health systems generate the majority of specialty prescriptions, and they’re best positioned to manage the patients who depend on them. That’s the work Visante is built to support. We partner with health systems through every stage of HSSP growth, from building the foundational workflows to scaling into more sophisticated operations. If you’re wondering how to get specialty pharmacy support, let’s talk.