Patients more likely to skip specialty medications when sent to pharmacies outside health system

Patients with oncology, multiple sclerosis or inflammatory conditions such as irritable bowel syndrome, rheumatoid arthritis or dermatology were able to get their medications faster through an integrated health system specialty pharmacy than through an outside specialty pharmacy, according to new research published in JMCP in February 2026.

An integrated health system specialty pharmacy is an in-house pharmacy within a hospital system. They handle prior authorizations for specialty medication and can help patients with copay and financial assistance. Approximately 25% of U.S. health systems have their own integrated specialty pharmacies, according to the Health System Owned Specialty Pharmacy Alliance.

“Patients whose prescriptions are sent to non–health system specialty pharmacies are less likely to start treatment, and when they do, they tend to start later than those using a single health system specialty pharmacy,” researchers wrote.

Led by Katie R. Cruchelow, Ph.D., project manager, Health Outcomes and Research Program at Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, researchers in the JMCP study wanted to compare primary medication nonadherence (PMN) of patients and prescription turnaround time of specialty medication received through an integrated health system specialty pharmacy and those using external specialty pharmacies. They defined nonadherence as the rate at which a prescription is written but not obtained by the patient.

They conducted a single-center retrospective study of patients who received specialty medication for oncology, multiple sclerosis or inflammatory conditions such as irritable bowel syndrome, rheumatoid arthritis or dermatology between June 1, 2021, and May 31, 2022. There were 1,466 patients with one eligible prescription (67% at the hospital specialty pharmacy and 33% at outside pharmacies). They were evaluated for primary medication nonadherence, as well as turnaround time for the prescription.

Prescription data were obtained from the electronic health records of Vanderbilt University Medical Center’s pharmacy, Vanderbilt Specialty Pharmacy. Outside specialty pharmacy data were obtained from Surescripts.

Researchers found that patients who had a prescription sent to an outside pharmacy had 60% higher odds of not picking up a prescription. Turnaround time for patients at a hospital pharmacy was a median of 3 (range of 1 to 6) days and a median of 4 (1 to 10) days for patients filling at an outside pharmacy.

The researchers said that not picking up the prescription and the turnaround time can be important indicators of patients’ ability to access and benefit from therapy and contribute to patient experience and treatment outcomes. They cite one study that suggests when patients with rheumatoid arthritis wait to start therapy, they have greater joint damage. Another study found that for patients with irritable bowel disease, those who had delayed insurance approval for a higher dose of their biologic medication had higher C-reactive protein levels, which measure inflammation.

A limitation of the study was its single-center design, and researchers said the findings may not be generalizable to other specialty pharmacies. They also did not have access to data about the reasons for patient nonadherence. Researchers speculate patients who did not pick up a prescription may have faced barriers such as prior authorization or financial assistance. But their research did not mention the impact of patients’ costs and nonadherence.