Specialty pharmacy is one of the fastest-growing and most essential parts of today’s healthcare landscape — and you’re likely already feeling both the opportunity and the pressure. As the number of patients diagnosed with chronic and complex conditions continues to rise, so does the demand for high-touch, clinically integrated pharmacy services that deliver measurable results.
You may have already taken the important step of building a health system specialty pharmacy (HSSP) program in-house. But as your program matures, it can hit barriers that are difficult to overcome on your own — from limited payer access to operational inefficiencies and staffing shortages.
We’ve seen this time and again: even the strongest DIY efforts can hit a wall. That’s where a flexible, proven partner can help you break through.
Why DIY Specialty Pharmacy Programs Hit a Wall
When you build a specialty pharmacy program, it’s a step forward in increasing your system-wide revenue, improving patient outcomes, and enabling a higher in-house fill rate across your patient population. You’ve made meaningful progress. But at a certain point, even the most well-resourced DIY programs hit barriers that make it difficult to scale further:
- Restricted access to payer networks and limited distribution drugs (LDDs) are among the most persistent challenges, often driven by vertical integration, complex credentialing requirements, and pharmacy benefit manager (PBM) exclusions.
- Operational and staffing constraints put pressure on teams to do more with less, slowing growth and innovation.
- Administrative and reporting burdens can quickly become unsustainable, especially as payers raise the bar on compliance.
These challenges can stall your program’s momentum. But with the right partner, you can fully unlock the financial and clinical value your specialty pharmacy program is capable of delivering.
The Case for Acceleration: What Shields Health Solutions Brings to the Table
Since 2019, more than 200 drugs have come to market through LDD networks — a nearly 20% increase from the prior five-year period. With access tightening, it’s becoming harder to keep pace without the right infrastructure and expertise.
If your in-house resources are already stretched thin, unlocking the full potential of your specialty pharmacy program may require strategic support. A flexible partner can help you overcome payer access limitations, staffing challenges, and operational roadblocks — without taking control away from your team.
This flexibility is core to how we work. Rather than offer cookie-cutter services, we deliver integrated, customizable solutions tailored to your health system’s specific needs, strategic goals, and growth stage. Whether you’re looking to improve patient access, scale capacity, or tap into new payer and drug networks, we can help you move faster and go further. We do this with the support of 20+ dedicated payer professionals who work daily to navigate both the written and unwritten rules of gaining access, ensuring your organization doesn’t face lockouts or unnecessary delays.
Retain Ownership, Gain Scalability
We meet you where you are — with a mix of on-site and centralized services aligned to your workflows. You keep ownership; we help you clear growth barriers.
Unlock Access
Our payer and trade teams help you gain entry into restricted payer networks and LDD channels. We provide our health system partners access to 90%+ of their specialty drug opportunity, and have secured pharmacy network access across a wide portfolio of regional and national health plans and PBMs. For specialty pharmacy payer access, Shields provides support across the continuum of contracting; from pharmacy readiness, to contracting and analytics, and then follow-on support with meeting ongoing network requirements. Our process ensures that once a pharmacy has joined a specialty network, they are able to remain in-network indefinitely.
Since 2021 alone, we’ve secured 438 contracts, unlocking $11B in incremental payer access across our network. Today, approximately 70% of the total $40B payer opportunity is accessible across the entire Shields network.
Streamline Operations
With tools like TelemetryRx®, your team can automate patient tracking and daily reporting, improve team coordination, and keep workflows running smoothly — all without adding to your already-busy workload.
Staff Smarter
Shields offers a flexible HSSP staffing model tailored to your unique patient and staff needs. Clinical pharmacist support scales with patient volume, enabling fractional FTE support and preventing over- or understaffing. We thoughtfully augment your team with certified and trained clinical pharmacists, liaisons, and support staff who provide personalized, high-touch care — freeing your clinicians to focus on direct patient care.
Meet (and Exceed) Industry Standards
Our infrastructure and integrated care model is purpose-built to stay ahead of rigorous payer and PBM requirements. We proactively guide partners through credentialing requirements, readiness reviews, and evolving documentation standards, ensuring health systems not only gain, but maintain, access. Subject matter experts in every facet of specialty pharmacy accelerate time to value, helping your program meet requirements quickly and confidently. Our experts also guide health systems to achieving dual accreditation with minimal operational friction, and provide ongoing support with future ACHC and URAC accreditation applications.
Tangible Results: Financial and Clinical Performance
We don’t just talk about great outcomes — we deliver them. Our model consistently delivers:
- Time to therapy in under 2 days
- 92% patient medication adherence rate
- Average copay of $10
- 13% reduction in total cost of care
For even more examples of how we’re helping health systems across the country scale smarter and faster, check out our 2024 Outcomes Report.
Real-World Transformation
When your in-house capabilities hit a ceiling, strategic collaboration can be the key to transformation. One not-for-profit health system partnered with Shields to launch their HSSP with a focus on diabetes care — an area traditionally overlooked by specialty pharmacy models.
Together, we implemented a highly tailored program, assigning pharmacy liaisons and support staff across 14 clinics. Within the first year, they served 1,500 patients and quickly reached revenue benchmarks seen at top-performing systems.
The result? Better outcomes, stronger operations, and a program that’s now equipped to scale with confidence.
Conclusion: A Smarter Path Forward
You don’t have to choose between control and growth. With the right partner, you can accelerate your specialty pharmacy program’s potential while retaining full ownership and staying true to your mission.
If your DIY specialty pharmacy program is ready for what’s next, we’d love to help you get there.