Key Findings from the 2025 Specialty Pharmacy Transformation Outlook Survey: How Specialty Pharmacies are Redefining Care, Embracing Technology and Preparing for the Future

As the U.S. healthcare system grapples with rising costs, clinician shortages, and the growing burden of chronic disease, specialty pharmacies are stepping into a larger, more strategic role. Once viewed primarily as dispensers of high-cost medications, today’s specialty pharmacies are transforming into community health hubs that deliver comprehensive, clinically integrated care.

Our 2025 Specialty Pharmacy Transformation Outlook Survey—featuring responses from nearly 100 leaders in the field—reveals how pharmacy organizations are navigating these changes, what they’re investing in, and the challenges they face.

Here are five key insights shaping the future of specialty pharmacy:

1. Pharmacists Are Poised to Play a Larger Role in Primary and Chronic Care

77% of respondents identified the expanded role of pharmacists in filling primary care gaps as the #1 growth opportunity in specialty pharmacy. With a growing shortage of providers and chronic disease prevalence on the rise, pharmacies are stepping up to help manage chronic conditions, support preventive care, and deliver personalized interventions.

In fact, many specialty pharmacies are already expanding their clinical service portfolios:

• 67% offer medication therapy management (MTM)
• 48% provide chronic care management
• 40% offer health and wellness consultations

This aligns with industry-wide efforts to move pharmacies from a transactional dispensing model to a value-based care hub focused on outcomes, access, and affordability.

Key Consideration: Add or expand health and wellness consultations, chronic condition management programs, or medication therapy management to enhance patient care and tap into new revenue streams.

2. Technology, AI, and Automation Are Top Priorities and Key to Scaling—But Barriers Remain

70% of respondents ranked harnessing technology, automation, and AI as the #2 opportunity for driving future growth. From optimizing patient engagement to automating workflows, technology is becoming essential to managing the complexity of specialty care. Organizations are especially focused on using:

• Predictive analytics to identify non-adherence
• AI to automate routine workflows
• Workflow automation for prior authorizations and refill management
• Real-time eligibility and benefits verification
• Cloud-native systems for secure, scalable infrastructure
• Interoperable systems to improve care coordination

However, existing technology limitations were called out as a significant obstacle. Respondents emphasized the urgent need to modernize platforms and adopt scalable, cloud-based infrastructure to support growth and compliance.

Key consideration: Add automated technologies with embedded AI to automate the workflow, improve operational efficiencies, enhance patient care, and increase scalability for continued growth.

3. Reimbursement Pressure and Policy Complexity Remain Top Challenges

The top concerns identified by pharmacy leaders include:

• Drug reimbursement challenges
• Ongoing policy and regulatory changes
• Staffing pressures, including stress, burnout, and low morale

In addition, 39% of pharmacies reported a shift from pharmacy benefit to medical billing, prompting a need for next-generation revenue cycle management and claims processing capabilities.

Respondents also noted collections rates below 49% for specialty drugs as a barrier, especially where billing complexities intersect with high-cost therapies.

Key consideration: Choose a medical billing solution with embedded AI to improve operational efficiencies and alleviate staff stress, simplify the complexity of medical claims management, reduce claim denials, automate appeals/denials management, and maximize reimbursements.

4. Strategic Expansion Is Driving Revenue Growth

Pharmacies that are investing in both specialty medications and clinical services are seeing meaningful business results. 38% of survey respondents who have expanded their offerings reported moderate or significant revenue growth.

The most significant areas of medication growth expected in the next 12–36 months include therapies for:

• Hepatitis C
• Sleep disorders
• Infertility
• Immune deficiency

Pharmacies are also increasing investments in digital therapeutics and specialty diagnostic testing to broaden their service footprint and deepen their role in patient care.

Key Consideration: Expand your specialty pharmacy program to include therapeutic categories that are most meaningful to your pharmacy’s patient population and improve the health of your business.

5. Medical Benefit Claims Pose Significant Operational Friction

39% of respondents report seeing a shift to the medical benefit pathway—rather than the pharmacy benefit. As a result, specialty pharmacies are encountering complex reimbursement hurdles that threaten margins and potentially impact patient care. The #1 medical benefit claim issue, according to respondents, is the inability to provide patients with up-front out-of-pocket cost estimates for clinical services—complicating care planning and financial transparency.

Other top-ranked issues by survey respondents include:

• Lack of visibility into reimbursement status
• Difficulty obtaining real-time financial and clinical eligibility data
• Delays and complexity in securing prior authorizations
• Limited visibility into claim status throughout the process

Together, these challenges highlight the urgent need for next-generation revenue cycle management tools that can streamline medical billing, improve patient transparency, and reduce administrative burdens.

Key consideration: Implement a revenue management solution to automate medical billing claims and provide visibility throughout the process to maximize reimbursements and cash flow.

Looking Forward

The specialty pharmacy model is undergoing a significant transformation—from reactive medication fulfillment to proactive health and wellness and chronic care management. As our 2025 survey shows, organizations that embrace technology, expand pharmacist-led services, and adapt to new care and payment models will be best positioned to thrive.

Want to see how your organization compares—and what others are prioritizing for 2025 and beyond? Download the full 2025 Specialty Pharmacy Transformation Outlook Report for a deeper dive into the trends, strategies, and innovations shaping the future of specialty care.