Specialty pharmacy leakage: What your program isn't capturing — and what to do about it
Annie Tran Manley, Senior Director of Specialty and Advanced Therapies at Accelerate Pharmacy Solutions, on how health systems can find and close the gaps in their specialty pharmacy programs.
How much is your specialty pharmacy program really leaving on the table? I've been asking that question a lot lately because it tends to open the most honest conversations.
After almost two decades in pharmacy, from processing transplant discharge orders as a pharmacy technician at UW Health to building and leading the specialty pharmacy at Cleveland Clinic and now partnering with health systems across the country, I've found that this question cuts through day-to-day operational noise and gets to what matters strategically.
The programs that built this space weren't built for this moment
I started my specialty pharmacy career on the frontlines of operations as a pharmacy technician when "specialty medications" were post-transplant regimens. From there, I became a pharmacist with a Walgreens specialty pharmacy in the "hepatitis C" era, when curative therapies hit the market, completely reshaping the industry overnight.
Those experiences led me to Cleveland Clinic, where I started their specialty pharmacy as a clinical pharmacist managing complex oncology patients, working through prior authorizations, and trying to shorten the time between a physician writing a prescription and a patient starting therapy. During my time there, I transitioned from direct patient care into program development and leadership, helping build the infrastructure, workflows, and ongoing case for what specialty pharmacy could become when it was resourced and positioned intentionally.
Each of these chapters shaped how I see this industry — aside from my personal career progression, each experience was a key inflection point that has transformed specialty pharmacy into what it is today.
What I learned is that most specialty pharmacy programs were built to solve a specific, immediate operational problem: reduce turnaround times, optimize the patient and provider experience, or implement new technology or workflows. The teams that execute on this do extraordinary work, often while under-resourced and proving the model in real time.
But having an operationally sound specialty pharmacy program and fully optimizing one are two very different things. The gap between them, measured in revenue, patient retention, and strategic positioning, is almost always larger than health system leaders expect when they finally see it clearly.
That gap is where the opportunity lives.
What you can't see is costing you more than you think
One of the most consistent patterns I see across health systems is specialty pharmacy leakage that no one has fully quantified. Your physicians are writing prescriptions for your patients, but those prescriptions are being filled outside your system, and revenue is leaving quietly — not because of a deliberate strategic choice, but because leaders lack visibility into how the percentage of captured prescriptions translates to dollars.
The reasons vary: prior authorization friction, manual workflows, service lines that were never fully integrated, or, most commonly, lack of system access to key manufacturer or payer contracts.
The question is not whether your program is performing. It is whether you have a clear enough picture of where it is not.
Specialty pharmacy touches far more of the enterprise than many organizations realize. It influences disease-state strategy, growth of outpatient services, patient retention across the care continuum, payer performance, and access to drugs before and after commercialization.
When pharmacy leaders translate specialty pharmacy performance into the metrics the organization already cares about, such as enterprise outpatient margins, patient retention, risk contract performance, and competitive positioning, the conversation changes. Pharmacy stops being viewed only as a cost center and becomes a strategic asset to be invested in.
Most pharmacy leaders have what they need to start that conversation. What they may not have is a clear, data-backed picture of where their program stands, where value is leaking, and what it would take to close the gap. That is exactly where Accelerate Pharmacy Solutions can help.
The gap is rarely about capability
When I work with health system pharmacy leaders, I am almost always walking into a room of talented, clinically sophisticated people who are managing an enormous amount and have not always had the bandwidth or outside perspective to step back and evaluate the full picture.
The gaps I find are rarely about capability. They are about visibility, workflows that have not kept pace with complexity, service models that have not adapted to industry headwinds, and programs optimizing operations without a clear line of sight to what the enterprise needs next.
I know what it feels like to be inside that work — confident in the clinical and operational quality, but too close to see the full strategic picture. That outside perspective is what I am most committed to bringing to health systems now.
The best time to evaluate your program is before you have to
The specialty pharmacy programs that will define the next five years will not be the ones that simply protect what they built. They will be the ones that use that foundation to add clarity, organizational alignment, and the right partners to grow.
That starts with knowing where you stand today — not where you think you stand, but where the data says you stand. How much opportunity is walking out the door? Where are the gaps between your current program and what your enterprise strategy needs it to be? What would it take to close them while keeping more patients, care and value connected within your health system?
Those are the questions I can help you address head-on with a complimentary specialty pharmacy opportunity assessment. If you are a pharmacy or health system leader who wants an honest, independent, data-backed view of where your program stands and what is possible, I encourage you to request one.
