What does the future of specialty pharmacy look like

Once a treatment is prescribed, patients may still need to navigate pharmacy selection, financial help and prior authorization before receiving their medicine. That fragmentation is not inevitable.

Prime Therapeutics (Prime) brings together medical and pharmacy insights, clinical expertise, benefit strategy and a broad network of pharmacy partners to make care work better for patients and clients. Unlike pharmacy benefit managers (PBMs) built around owned pharmacy assets, Prime can evaluate each solution based on patient needs, clinical appropriateness, client priorities and local market needs - not on where a prescription generates revenue for the PBM. That difference helps align decisions around better outcomes, appropriate access and lower total cost of care.

"The future of pharmacy should make it easier for patients to access care, understand their benefits and stay on therapy," said George Van Antwerp, senior vice president of product innovation and strategic planning at Prime. "We are working toward that future by connecting medical and pharmacy insights, aligning decisions around patient value and using technology to simplify routine steps. Our top priority will always be supporting patients when it matters most and helping keep healthcare affordable."

Three shifts shaping the future of specialty pharmacy

Scientific advances, economic pressures, digital transformation and greater regulatory transparency are reshaping pharmacy. But progress will require more than new tools. It will require a different model - one that aligns patient outcomes, clinical decisions and affordability instead of rewarding disconnected choices or steering care to owned assets. Prime is built to operate that way, working across payers, providers, pharmacies and drug manufacturers to find the solution that best serves the patient and the client.

This collaboration is especially important for specialty medicines, which account for a growing share of drug development and spending. Prime data show that, on average, 2% of members account for 55% of net drug spending.

Three shifts show how the industry is responding:

1. Care is becoming predictive. Precision testing, companion diagnostics and connected medical and pharmacy data can help care teams identify medication risks and act sooner. Prime applies this approach through HighTouchRx^®, which uses predictive analytics and pharmacist support to identify drug therapy that may not be optimized. By aligning data, clinical expertise and benefit strategy around the patient, the program can help prescribers select safer, more cost-effective therapy. Since 2022, the program has delivered more than $332 million in savings, with about $15,000 per successful case, according to the latest internal data.
2. Outcomes are becoming the basis of value. Value will increasingly depend on whether a treatment improves patient outcomes and total cost of care. Prime can evaluate solutions based on what is clinically appropriate for patients and what best meets client and local market needs. IntegratedRx^® shows what that alignment looks like in practice by keeping pharmacy care connected to the physicians managing a patient's treatment and supporting provider and patient choice. Through better coordination and fewer treatment delays, the program has delivered more than $150 million in total client savings and reduced total medical cost of care by 9% for patients with cancer, according to the latest internal data.
3. Experience is becoming the competitive advantage. Patients judge the pharmacy experience by how easy it is to access care, understand next steps and get support when they need it. A better experience depends on incentives that favor the right care setting and meaningful patient choice. Prime's Advocate+™ Pharmacy Match offers personalized guidance while preserving patient and provider choice. It matches patients with qualified specialty pharmacies based on cost, care and experience, helping connect each patient with the pharmacy best positioned to support their treatment.

Together, these shifts show what Prime's model makes possible. Connected medical and pharmacy data help identify risks earlier. Independence from owned pharmacy assets supports more coordinated decisions and meaningful patient and provider choice. Clinical expertise and technology can then reduce friction and better manage total cost of care.

"That is the future of pharmacy: aligning decisions around patients, anticipating their needs, measuring value through outcomes and creating a simpler, more supportive experience," Van Antwerp said.