In the evolving landscape of specialty pharmacy, the need for strategic collaboration between integrated delivery networks (IDNs), payers, and manufacturers has never been greater. At Asembia 2025, panelists representing health systems, pharmaceutical companies, and specialty pharmacy operations discussed how better alignment can improve patient outcomes and lower total cost of care.

Moderated by Stephen Davis, PharmD, MS, FASHP, vice president of health system experience and strategy at Shields Health Solutions, the session featured Joshua Weber, PharmD, MBA, CSP, of UVA Health; Bruce Wilson, BS, vice president of US oncology care and access at AstraZeneca; and Kim Tedesco, RPh, director of gene and cell therapy pharmacy operations at Walgreens Gene and Cell Services. Their dialogue highlighted the challenges, opportunities, and future direction of specialty pharmacy, particularly as it relates to complex therapies such as cell and gene treatments.

Growth Pressures and the Expanding Role of Specialty Pharmacy

Davis opened with statistics underscoring the growth trajectory of specialty pharmacy: 80% of US Food and Drug Administration (FDA) drug approvals in 2023 were specialty therapies, and 52% in 2024 target rare diseases. Specialty dispensing channels collectively accounted for $265 billion in 2024, an 8% increase from the previous year, with expectations for continued expansion. As therapies grow more sophisticated, stakeholders face pressure to match operational models to clinical complexity.

Weber noted that the specialty space—especially around rare and cell and gene therapies—is at a pivotal moment, with challenges like PBM reform and 340B pressures looming.

“It’s also a significant opportunity to not just be transactional in how we approach collaboration, but transformational in how we can address and reimagine what the specialty pharmacy ecosystem is,” Weber said.

Value Over Volume: Manufacturer Contributions to Outcomes

Wilson addressed the manufacturer’s role in improving outcomes, particularly through education and patient support services that ensure adherence and informed treatment expectations. He emphasized the need for pharmaceutical companies to better demonstrate a drug’s total value—including long-term savings from reduced hospitalizations or complications—even when upfront costs are high.

Tedesco added that economic architecture must evolve to support the growth of high-cost therapies, with specialty pharmacy positioned to lead this change due to its centrality in the patient journey.

Redesigning Access Models and Scaling Centers of Excellence

As an IDN leader, Weber described UVA Health’s approach to specialty pharmacy as one that moves beyond fulfillment. UVA has built scalable centers of excellence designed around early site activation, rare disease certification, and comprehensive patient journey mapping.

This infrastructure, he explained, supports faster infusion readiness despite barriers such as long benefit verification timelines and the logistical challenges of administering therapies that may only have a single-dose opportunity for cure.

Payers, IDNs, and the Shift to Value-Based Care

As value-based care models gain traction, the alignment of incentives across stakeholders remains essential. Weber stressed that outcomes-based contracting will only succeed if everyone agrees on what “value” means. When misaligned, these models risk creating inefficiencies, waste, and patient frustration. With robust internal data from integrated electronic health records, IDNs like UVA are increasingly equipped to generate insights that demonstrate reduced emergency department visits and improved adherence.

Wilson and Tedesco acknowledged the persistent access issues that affect patient equity—particularly in the case of cell and gene therapies, which are often only available at select academic centers. Distance from administration sites and institutional capacity constraints limit access for many eligible patients, they noted, adding that long-term monitoring and coordination across health systems and specialty pharmacies are critical for success.

“If a drug exists but I can’t actually get it because I can’t get access to it, does it really matter that it exists?” Wilson asked.

Pharmacists at the Center of Continuity

Pharmacists are playing a growing role in ongoing care coordination. Tedesco emphasized that pharmacists interact with patients far more frequently than other providers and are uniquely positioned to monitor post-treatment health, triage concerns, and ensure medication adherence. Specialty pharmacists are expanding their presence in clinical settings, working under collaborative practice agreements to manage therapy decisions and proactively switch to payer-preferred biosimilars.

Weber detailed UVA’s embedded clinical pharmacy model, which integrates over 75 pharmacists across 25 therapeutic areas. This model facilitates rapid prescribing, adherence monitoring, and payer engagement, especially when built into electronic prescribing systems.

Data Sharing, AI, and the Future of Collaboration

Looking ahead, the panel agreed that data—and how it is shared—will drive future innovation. Weber described how UVA is using artificial intelligence (AI), natural language processing, and predictive analytics to structure and visualize data across the patient journey. These insights allow the health system to demonstrate value to both payers and manufacturers while optimizing internal quality and cost metrics.

Tedesco and Wilson noted that next-generation models will likely feature more robust remote monitoring and advanced analytics to detect early signs of treatment failure or patient risk. Success will depend on developing scalable, nimble solutions that can adjust to payer preferences, therapy-specific needs, and emerging real-world evidence requirements.

Collaboration Is Key

The session concluded with a consensus: collaboration across manufacturers, payers, and IDNs is no longer optional—it is foundational. Panelists envisioned a future in which success is measured not only by therapy launches but by the strength of the ecosystems that support patients from diagnosis to long-term care.

“I really think the future of specialty pharmacy will not be defined by these product launches alone,” Weber concluded. “It’s going to be defined by the strength of the ecosystems that we all build together.”

Reference

Davis S, Weber J, Tedesco K, Wilson B. Collaboration in action: uniting payers, manufacturers, and IDNs. Presented at: Asembia 2025; April 29, 2025; Las Vegas, NV.