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Insight
When technology is embedded within existing workflows, health systems can streamline specialty pharmacy operations for stronger patient outcomes and margins.
We’re in the midst of a transformative moment for specialty pharmacy operations.
Specialty pharmacy today accounts for 56% of all U.S. drug spending[0] Josh Nelson, Megan Preiner, Joan Thompson, and Ben Stern. Navigating the Complexities of the Specialty Drug Market. THL, 17 May 2024., and many health systems are bringing this powerful driver of growth and clinical impact in-house: Hospital-owned specialty pharmacies are projected to see more than 10% annual profit growth through 2028.[0]Shubham Singhal and Neha Patel. What to expect in US healthcare in 2025 and beyond. McKinsey & Company, Jan. 2025.
But as the specialty pipeline expands, so do the challenges. Reimbursement regulations are tightening, and teams are being asked to do more with less.
This moment calls for a solution that truly works for health systems: technology that embeds real-time data visibility, automation for access and claims, and affordability support integrated into existing pharmacy workflows.
CoverMyMeds understands these critical workflow pressures and has built a solution for health systems around these qualities to empower teams without disrupting them.
Health system pharmacies today need to serve as hubs for complex, high-touch therapies, responsible for bridging the gaps across in- and outpatient settings. The shift to supporting an extended care journey at multiple sites brings new pressures:
These realities are reshaping the role of the pharmacy within the health system. We’re no longer just dispensing medications, but driving patient and financial outcomes at the center of coordinated care.
“Health systems are under immense pressure to deliver specialty care without disrupting workflows,” says Mike Cohn, CoverMyMeds’ Vice President of Network Operations. “The future of specialty pharmacy depends on solutions that work within existing systems, not against them.”
“Health systems are under immense pressure to deliver specialty care without disrupting workflows."
Health systems need partners who solve for complexity rather than adding to it. Too many short-sighted solutions ask pharmacies to give up control, fit into rigid networks or rely on outside intermediaries.
CoverMyMeds solutions, by contrast, are rooted in flexibility and scalability. Our technology works within your existing systems to connect your people with your own data and workflows.
Our solution is centered around three essentials:
1. Simplify patient access and affordability
To give patients timely access to therapies, affordability and safety tools need to be directly integrated into health system pharmacy workflows.
Our technology automatically applies co-pay assistance to qualified medications, and cash pay options when available, then helps resolve claims and prior authorization barriers within existing systems. At the same time, real-time safety notifications let pharmacists catch potential errors and have more meaningful, informed conversations at the counter.
“Pharmacists are on the front lines of medication access, and we see firsthand how affordability and coverage challenges impact patients,” says Dimple Patel, PharmD, Senior Director of Product Management. “Integrated tools like real-time adjudication and auto-applied savings can make a huge difference, reducing abandonment and improving adherence. When we embed these solutions into workflows, it empowers pharmacies to focus on what matters most: helping patients start and stay on therapy.”
2. Automate routine pharmacy tasks
We bring automation and connectivity into pharmacy management systems your team already uses every day, and the payer and hub portals you navigate for claims.
Our tools automate routine steps like benefit verification, prior authorization submission, and claim resubmission right inside those existing workflows—and link inpatient and outpatient pharmacy systems for a seamless view. What once took significant time and created the possibility for errors due to extra logins and phone calls now happens automatically, so your staff can focus on care instead of clicks.
3. Protect margins in real time
We help health systems protect revenue and reduce risk by building automation into the places where financial leakage often occurs. Our tools:
Instead of adding reports to analyze, CoverMyMeds delivers insight right inside your existing systems. This improves data visibility and audit readiness to support evolving accreditation requirements and outcomes-based contract reporting. Your team can work smarter, stay compliant, and protect revenue.
“Pharmacists are on the front lines of medication access, and we see firsthand how affordability and coverage challenges impact patients.”
Specialty pharmacy is now central to the ways that health systems deliver care. Purpose-built for health systems, CoverMyMeds’ technology integrates with your platforms to simplify operations and strengthen patient care.
We know the challenges won’t slow down, but neither will the innovation happening inside your pharmacies.
Let’s build the future of pharmacy together.