Xccelerate 2026: Rebuilding Specialty Pharmacy for Speed and Scale

Specialty pharmacy Is central to clinical and financial performance

At Xccelerate 2026, we convened health system pharmacy leaders to discuss a growing reality: specialty pharmacy is now the front line of care delivery. 

Health system pharmacy leaders are facing a consistent set of operational challenges in specialty pharmacy. Patients are waiting too long to start therapy, prior authorizations continue to create delays and rework, and teams are operating across multiple disconnected systems. Even with significant effort from pharmacy, clinic, and administrative teams, performance is often inconsistent and difficult to scale.

The most important shift is not that specialty medication usage is growing. It is that the pipeline is increasingly specialty-led. That changes the operating model question for health systems: are we built for predictable access at scale, or are we still relying on heroic effort to push each patient through?

“If you look at what’s happening currently in the market, 85% of the FDA pipeline is now considered specialty meds.” - Jigar Thakkar, CEO, Longitude Rx

Specialty pharmacy is now a core operating priority for health systems

Specialty pharmacy performance has a direct impact on clinical outcomes, patient experience, and financial sustainability. As specialty utilization grows and payer requirements continue to evolve, delays in therapy initiation are becoming a measurable system issue, not an isolated operational inconvenience.

This is why access has become the most honest measure of specialty performance. Not in a marketing sense. The specialty journey includes benefits investigation, prior authorizations, financial assistance, restricted distribution networks, documentation loops, and dispensing workflows. Any one of these can slow therapy starts. Several together can derail them.

So the operating principle becomes simple: reduce friction, shorten the chain, and make progress visible.

The north star metric: time to therapy

For many health systems, specialty pharmacy is no longer a niche service line. It is a core part of how patients access treatment, and it has a direct impact on both clinical outcomes and financial performance.

One of the most consistent themes across the discussion was the importance of measuring and managing time to therapy. This refers to the time between when a medication is prescribed and when the patient actually begins treatment. While many programs track a range of operational metrics, time to therapy provides a more complete view of performance because it captures the combined impact of benefits verification, prior authorization, financial assistance, and dispensing workflows.

“One of the main KPI that I think all of this really boils down to for specialty meds is time to therapy… It sounds like a simple thing, but for specialty meds it’s not as simple as that.” -  Jigar Thakkar, CEO, Longitude Rx

Delays are rarely caused by a single issue. In most cases, they result from a series of small breakdowns across the process, often across different teams and systems. Pharmacy, clinic staff, revenue cycle, and external partners all play a role in moving a patient from prescription to therapy initiation. Without clear visibility across these steps, it is difficult to identify where delays are occurring and how to address them.

Build around a balanced scorecard, not a single win

Optimizing for speed alone can create its own failure modes. Fast starts do not matter if patients fall off early. Great clinical support does not matter if the model cannot sustain itself. And financial performance does not matter if patients experience the program as a maze.

The strongest approach is a balanced scorecard that connects operational, clinical, and financial truth into one view of performance. Time to therapy tells you whether the system can move. Adherence tells you whether patients are supported after initiation. Capture rate tells you whether the organization is retaining specialty volume and building a sustainable model.

“From an operations perspective time to therapy… from a clinical perspective the 90-day adherence… and from a financial perspective the capture rate.” -  Urshila Shah, Chief Pharmacy Officer, WMCHealth Network 

The point of a balanced scorecard is not reporting. It is decision-making. It helps leaders invest in the right constraints instead of optimizing the loudest problems.

Embed the work where specialty decisions are made

Many of the delays in specialty pharmacy originate at the point of prescribing. Incomplete documentation, missing clinical information, and unclear next steps often require follow-up after the patient has left the clinic. This creates back-and-forth between pharmacy, providers, and payers that can add days to the process.

To address this, several health systems have moved to embed pharmacy teams directly within specialty clinics.

“We call them our embedded team and they are integrated directly into our specialty clinics… They’re shoulder to shoulder in those clinics with the physicians.” -  Ashley Van Allen, National Director, Ambulatory Care Pharmacy Services at Ascension

Embedding pharmacy capabilities upstream allows teams to ensure documentation is complete, initiate benefits verification earlier, and align on financial assistance options before the patient leaves the visit. Leaders reported that this approach reduces rework and shortens time to therapy.

Embedding is not just a staffing decision. It is a design decision. It makes access a clinic outcome, not a downstream pharmacy burden.

The hidden cost center: swivel-chair work

Another consistent challenge is the level of fragmentation across systems. Specialty pharmacy teams are often working across the electronic health record, prior authorization tools, dispensing platforms, financial assistance systems, and 340B infrastructure. In many cases, these systems are not well integrated, which requires staff to re-enter information, track status manually, and switch between systems to complete routine tasks.

This is where technology should earn its keep: not by adding “another tool,” but by removing the constant pivoting that drains time and attention.

“Our team is constantly pivoting between all of these different systems… We want to make sure whatever technology we select, it’s integrated into the workflow, because if people are having to jump out of it, it just creates noise.” -  Ashley Van Allen, National Director, Ambulatory Care Pharmacy Services at Ascension

This level of fragmentation increases the time required to move patients through the process and makes performance more dependent on individual effort. Several leaders noted that adding new tools has not solved this problem. In many cases, it has increased complexity. The focus is shifting toward integrating workflows into existing systems, particularly the EHR, and improving visibility into patient status across the specialty journey.

What this means for specialty pharmacy leaders

Improving access to specialty medications requires changes across people, process, and technology. Most organizations are not dealing with a single constraint but a set of interconnected challenges. Addressing these challenges in a coordinated way is what allows health systems to improve both patient experience and operational performance in specialty pharmacy.

Watch the full episode here: https://innovaccer.com/xccelerate-sessions/maximizing-specialty-pharmacy-performance 

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