Beyond the Prescription: Specialty Pharmacy’s Role in Targeting Social Determinants of Health

This National Pharmacy Week, Oct. 18-24, we highlight a less visible yet indispensable role of specialty pharmacies and pharmacists: going beyond the prescription to target the social and environmental factors that shape health outside hospital walls. Social determinants of health (SDOH) are nonmedical circumstances, such as the patient's ZIP code, education level, income level, or insurance status, that can directly affect health outcomes. In fact, medical care accounts only for an estimated 10-20% of population health outcomes, while SDOH contribute as much as 80-90%, according to the National Academy of Medicine.

Chicago's Health Disparities Highlight Need to Target SDOH

Despite recent progress, there is still much work to be done to address how SDOH affect communities like Chicago. Although overall life expectancy in Chicago is on par with the national average of around 77 years, there is currently a 9.4-year life expectancy gap between Black and non-Black residents, according to the Chicago Department of Public Health. This gap is driven by longstanding inequities in SDOH.

Association member Sinai Chicago, the city's largest private safety net health system, partnered with Clearway Health in 2025 to launch a hospital-owned specialty pharmacy program. The program aims to help patients access high-cost and complex-to-manage medications and reduce social and economic barriers to care.

Specialty Pharmacy's Role in Reducing SDOH's Impact

Integrated health system specialty pharmacy programs are well-positioned to address SDOH and improve access to care. By embedding pharmacists and patients within specialty clinics, these programs provide personalized support throughout the medication journey and improve access to care in several ways.

1. Reducing Financial Barriers to Specialty Medications
   Specialty pharmacy programs help health systems manage prescriptions and financial assistance programs and verify patient eligibility so they can begin treatment quickly. These programs help patients navigate insurance benefits and expedite prior authorizations. They also help hospitals optimize 340B Drug Pricing Program savings so they can reinvest in patient care and community services, such as opening trauma centers and food pantries, establishing clinical pharmacy programs, helping patients afford medications, and creating partnerships to offer housing and educational opportunities. The 340B program is essential for extending care to patients who face significant financial and other barriers to access.
   
   
2. Improving Medication Safety, Adherence, and Understanding
   Many patients essential hospitals serve, particularly those with low incomes and from historically underserved communities, face challenges navigating complicated medications and adhering to treatment plans, negatively affecting clinical outcomes. Through comprehensive patient counseling, specialty pharmacy teams help patients avoid misunderstandings that could cause adverse drug events, reduce medication administration and dosage errors. These interventions generally help patients adhere to medications throughout their treatment, reducing hospitalizations and complications while promoting medication safety and improving patient outcomes.
   
   Many essential hospital patients have limited health literacy, language barriers, inadequate social support, and other social factors that affect medication adherence. Specialty pharmacy teams educate patients on their specific medical conditions so they can better understand, manage, and participate in their care. Culturally appropriate communication and language interpretation services or bilingual pharmacy liaisons help improve health literacy. The extensive education and guidance these onsite teams provide significantly help patients understand and manage high-cost specialty medications.
   
   
3. Delivering Specialized Care Coordination and Ongoing Support
   Many underserved patients and those living in rural communities face transportation and logistical challenges receiving their medications. Specialty pharmacy teams provide home medication delivery and clinical check-ins and call patients to schedule refills. They document all encounters for provider reference. Specialized care coordination and ongoing support further reduce barriers to treatment.

Sameer Shah, PharmD, MHA, president, Mount Sinai Hospital, Sinai Chicago, speaks to the 340B program's impact on access.

"I think the biggest impact [of the 340B Program at Sinai Chicago] has been access and making our service lines more comprehensive," he said in a recent interview. "You can have all the innovation in the world. Pharmaceutical companies are creating amazing therapies and treatments. And if your communities don't have access, it's not a good feeling."

Sinai Chicago has invested 340B program savings to expand care, add service lines, and establish new specialties, serving patients closer to home while removing barriers to access.. Creating multidisciplinary care teams has eased physician and clinical burden. Using 340B program funding, Sinai Chicago launched a patient assistance program for underinsured or high-copay patients to reduce or eliminate the cost of their medications. In the first four months of establishing the program, 22 patients who otherwise would not have been able to afford this cost received financial assistance.

"Many of our patients require more work and help," Shah said. "Being able to add community health workers, [specialty pharmacy patient] liaisons, and navigators within a care team is really a big lift for our services. And we've been able to see great outcomes through that. Embedding pharmacists in these clinics is important. It's ideal."

Specialty pharmacy connects SDOH and quality of care, driving access and outcomes for patients