Keeping Care Connected: Closing Visibility Gaps in Specialty Pharmacy

“Can I fill this prescription?”

For most of my decade-long career as a pharmacist working inside health systems, this question sat at the center of my day-to-day work.

However, the answer isn’t always straightforward. Access barriers are often outside your control. Certain exclusive therapies or limited-distribution drugs are impossible for a health system pharmacy to dispense regardless of patient need or provider preference.

Prescriptions also leave the system for less visible reasons: referral patterns, patient preference, manufacturer restrictions, payer network requirements, or workflow gaps that redirect patients elsewhere before the health system has an opportunity to support them. As of 2026, more than six in 10 health system specialty pharmacies reported only being able to fill less than half of the specialty prescriptions their organizations generated, most commonly because of payer network restrictions.¹

As a pharmacist, my priority was always getting my patients the treatment they needed. But once the prescription was transferred, I faced a visibility gap into whether the medication was filled, how quickly treatment started, or the patient’s progress throughout their care journey.

The prescription itself is only part of what leaves the system. Health systems lose access to critical information about patient adherence, treatment progress, and clinical outcomes. Ultimately, that creates challenges for care coordination as well as operational, financial, and growth decision-making.

When the Prescription Goes Out the Door, So Does Visibility

Gaps in the Care Continuum

When a specialty prescription gets filled through an external pharmacy, health systems lose touch with important aspects of care. For example, whether or not the prescription was actually filled, or how quickly treatment began, or how side effects were managed.

As that information becomes harder to access, wide gaps develop across the continuum of care.

• Providers receive a less complete picture of a patient's treatment experience, making it more difficult to coordinate care and support smooth transitions across different settings.
• Care teams spend additional time gathering information from external partners instead of focusing on patient support and intervention.
• Health system leaders can’t accurately evaluate the performance of the specialty program, or identify growth opportunities when data on patient outcomes, medication utilization, and referral patterns exist outside their line of sight.

For organizations investing in specialty pharmacy and infusion services, that lack of visibility creates a wide chasm between care delivery and the insights needed to continuously improve it.

During my time leading a health system specialty pharmacy, I cared for many oncology patients whose prescriptions were required to be filled through external specialty pharmacies due to insurance network requirements. In one case, a patient was prescribed an oral cancer therapy and the care team expected treatment to begin within days. However, at a follow-up visit, we learned the patient had never started therapy because of outreach and financial assistance barriers that were not visible to the clinic. As a result, treatment was delayed by more than a month.

That experience highlighted how easily gaps in the care continuum can develop when health systems lose visibility into the specialty medication journey. Without insight into treatment initiation, adherence, and patient progress, providers spend valuable time tracking down information rather than proactively supporting patients and improving outcomes.

Impacted 340B Value

Specialty prescriptions that leave the system, particularly those tied to limited distribution or exclusive drug networks, may also carry unrealized 340B savings for eligible covered entities to support patient care programs and specialty pharmacy services. If fills are concentrated among a small number of pharmacies, there might be opportunity for a contract partnership to preserve data and savings that would otherwise leave the organization.

The complexity of the 340B landscape, including 340b contract pharmacy restrictions, reinforces the need for discipline. Manufacturer restrictions, evolving participation requirements, credentialing expectations, and ongoing policy changes require careful program stewardship.

Achieve More for Patient Care Continuity with a Trusted Partner

For many health systems, the question is not “How can we prevent specialty prescriptions from leaving the organization?” Certain products, payer networks, and manufacturer access requirements make that inevitable.

The more important question is how to maintain continuity when they do.

The right external specialty pharmacy relationship can help organizations stay connected to patients even when dispensing occurs externally. Rather than functioning as a separate endpoint in the care journey, the right partner becomes an extension of the health system's specialty pharmacy strategy.

Biologics By McKesson was built around this philosophy. By functioning as part of the extended care team, Biologics works alongside the health system to support patients receiving complex therapies:

• Dedicated care support across the treatment journey. Biologics' pharmacists, registered nurses, and patient access teams help patients navigate treatment. At the same time, it supports providers through prior authorizations, appeals, and other access-related challenges. This helps patients start therapy sooner and stay closely connected to the care they require.
• More patients remain connected to the health system. Biologics is designed to complement health system specialty pharmacy programs. If a referral is received for a medication that the health system can dispense internally, it is returned to the organization. For therapies that cannot be filled internally, Biologics serves as an extension of the care team by helping preserve continuity throughout the patient journey.
• It closes visibility gaps for the health system. Biologics helps close information gaps after a prescription leaves the system by sharing patient-level information such as prescription status, fill activity, clinical documentation and other relevant treatment updates. This continuity enables a health system’s providers, pharmacists, and care teams to maintain a more complete view of the patient experience, making better-informed care decisions.
• 340B value can be preserved. Health systems may be able to maintain access to certain 340B opportunities while ensuring patients receive medications from the pharmacy best positioned to serve This approach focuses on preserving value from prescriptions that were likely to leave the system no matter what, without requiring unnecessary changes to prescribing patterns or workflow.

The Biologics partnership model expands access to specialty therapies, maintains continuity of care, and reinforces specialty pharmacy performance.

As pharmacists and healthcare leaders, our responsibility to the patient does not end when a prescription leaves our four walls. Their journey continues whether we are there to help or not. The health systems that remain connected to that journey are better positioned to coordinate care, support providers, and create a more seamless experience for patients navigating complex therapies.

Sources:

1: https://academic.oup.com/ajhp/advance-article/doi/10.1093/ajhp/zxag130/8662538