Specialty pharmacy care model improves diabetes outcomes while lowering costs | Asembia AXS2026 Summit

Health systems can use specialty pharmacy programs to improve outcomes and control costs, but making these models financially sustainable remains a key challenge, speakers said at the Asembia Specialty Pharmacy Summit this week in Las Vegas.

At a session on value-based care, Samir Malkani, M.D., clinical chief of the division of diabetes, endocrinology and metabolism at UMass Memorial Health, and Bill McElnea, vice president of population health at Shields Health Solutions, shared data based on a UMass program supporting patients with complex conditions such as diabetes.

The model focuses on high-touch pharmacist care, where trained coaches help patients manage multiple medications and improve adherence. According to Malkani, many patients with diabetes take several drugs each day, making education and support critical.

He shared that the revenue generated from filling prescriptions, along with 340B support, helps offset the cost of the coaches, making the model cost neutral while improving patient outcomes.

Pharmacists in the program also help address a growing workforce gap and allow care to be delivered through telehealth, reducing the need for clinic space. Additionally, the program uses digital tools such as continuous glucose monitors to guide treatment decisions.

McElnea said long-term success depends on breaking down financial silos that separate pharmacy revenue from value-based care performance.

“I would say that if there's really sort of a policy or health system infrastructure bridge that needs to be built, it’s really trying to do away with those silos best we can so that people can see the full financial picture, and they can see the full financial impact of a diabetes care coach reducing total medical expense by over $2,600 just in year one, which is impacting the ACOs’ performance,” McElnea said. “But then also, because of the trust they're building with those ACO patients, a lot of them are choosing to fill with the UMass Specialty Pharmacy.”

The program also removes cost barriers for patients by offering services at no charge, which has helped drive participation.

Speakers said the approach shows how specialty pharmacy can play a larger role in population health, especially as health systems look for new ways to manage chronic disease and control the total cost of care.