The general specialty drug market has grown dramatically over the previous decade and this pattern is predicted to proceed for at the least the subsequent 5 years. Healthcare techniques, sufferers and pharmacies will face altering market dynamics that pose challenges to delivering specialty care, together with value will increase, an growing old inhabitants driving higher use, and a rising wave of progressive therapies that deliver new sufferers to the specialty pool add.

In response, healthcare techniques have elevated their give attention to integrating specialty pharmacy care to incorporate the wants of pharmacies of their hospitals to assist enhance affected person outcomes and experiences. By 2028, healthcare system-owned specialty pharmacy applications are anticipated to seize greater than 25% of the specialty pharmacy market by providing a extra environment friendly and efficient mannequin of look after sufferers.

Most giant healthcare techniques have a bonus in responding to trade modifications as a result of they function in-house specialty pharmacy applications. These applications have change into an essential a part of the expansion technique for a lot of healthcare techniques, with greater than 95 p.c of huge healthcare techniques working their very own in-house specialty pharmacy program. With these built-in specialty pharmacy capabilities, healthcare techniques can reply to altering market dynamics, enhance affected person outcomes whereas decreasing the general value of care, and use the specialty pharmacy program to assist healthcare system growth. Looking forward to 2025 and past, these are the important thing market dynamics that healthcare leaders will lean on in-house specialty pharmacies to deal with.

Responding to market dynamics

Since 2019, greater than 200 medication have entered the market by restricted distribution networks (LDD), a rise of almost 20 p.c over the earlier five-year interval. Normally, the healthcare system offers this care, underscoring the important profit of getting an built-in specialty pharmacy care mannequin in place to seamlessly deal with these affected person populations.

Current years have seen vital modifications within the dynamics of the specialty pharmacy market, particularly in terms of 340B contract pharmacies. Mainly, the 340B program offers drug reductions for hospitals that serve underserved sufferers. A number of dozen drug producers have imposed restrictions on how 340B medication could also be distributed exterior the lined entity, or well being care system, that purchases the drug, considerably limiting using contract pharmacies. Healthcare techniques with built-in specialty pharmacies can assist scale back these losses by bringing these prescriptions again in-house, whereas offering improved providers and outcomes for sufferers. The techniques that enhance their give attention to recapturing this enterprise by on-site applications can even additional develop these 340 billion assets to assist extra affected person care.

Rising therapies create alternatives and challenges

GLP-1 medication, together with Mounjaro and Ozempic, have dominated the highlight as promising new therapies for sort 2 diabetes, weight problems and a rising listing of different attainable indications. As of late, lots of my conversations with healthcare techniques inevitably revolve round weight reduction drugs and their potential implications.

The brand new therapies current each alternatives and challenges because the GLP-1 market evolves, with new producers coming into the market and new indications rising. These modifications create a necessity for structural assist round therapies. Sufferers, pharmacists and prescribers want up-to-date knowledge, instructional assets and monetary assist mechanisms to make sure that the brand new therapies can notice their full affect.

GLP-1s are a reminder of the fixed buzz of biotech innovation and the particular potential of built-in healthcare techniques to assist sufferers entry new therapies which are regularly coming to market. This increase in new medication creates the necessity to tackle new avenues of entry for sufferers, particularly within the areas of uncommon and orphan ailments, together with metabolic dysfunction-associated steatohepatitis.

Complicated and costly specialty therapies are sometimes distributed to a restricted variety of hospitals and pharmacies, therefore their designation as 'restricted distribution medication'. I anticipate that many new merchandise will comply with the restricted distribution path and that drug producers will depend on healthcare-based specialty pharmacies for distribution.

New partnership fashions

Because the healthcare specialty pharmacy channel continues to develop, we anticipate extra insurers and pharmacy profit managers (PBMs) – a third-party firm that acts as an middleman between insurers and pharmaceutical producers to handle prescription drug advantages – will search to collaborate working with healthcare system networks.

The purpose of these partnerships: higher affected person outcomes and decrease prices.

Each insurers and PBMs play a important position within the healthcare ecosystem, and there has by no means been a higher want for brand new collaboration fashions given the variety of specialty sufferers and the rising value of their drugs.

By partnering with specialty pharmacies throughout the healthcare system, insurers and PBMs can present sufferers with personalised assist, together with remedy adherence applications, care coordination, and assist navigating insurance coverage protection. This built-in strategy helps optimize remedy outcomes and management the excessive prices related to specialty drugs. It additionally helps sufferers all through their journey in coping with advanced ailments. These diagonal partnerships create a extra sustainable healthcare ecosystem, the place historically disparate entities work collectively to cut back prices and deal with sufferers extra holistically.

A altering market has positioned specialty pharmacy care on the middle of conversations about enhancing the standard and price of affected person care normally. With an elevated place within the healthcare ecosystem, built-in specialty pharmacies should put together for the altering tides and discover methods to optimize affected person care. By constructing methods round new laws, rising therapies and forging partnerships that may enhance affected person care, they’re uniquely positioned to ship vital worth to a quickly rising affected person pool.

Specialty pharmacies will proceed to play a important position within the monetary and operational efficiency of healthcare techniques throughout the nation. Because the specialty market continues to evolve, healthcare techniques are uniquely positioned to offer vital worth to the steadily rising variety of sufferers and develop and enhance entry to care and remedy. These therapies embody offering high-touch care to new affected person populations handled with advanced therapies and entry to evolving partnership fashions with payers and PBMs that assist capitalize on financial savings. The long run seems brilliant for the built-in specialty pharmacy mannequin – for healthcare techniques, suppliers and, most significantly, for sufferers.