Enabling Pharmacy Access 
and Affordability

As specialty drugs shift to the medical benefit, payers need visibility across site of care, pharmacy benefits, and total cost of care to manage spend well.

The gene therapy pipeline is accelerating, and payers that treat it as a future problem are already behind. From financial modeling to prior authorization design to proactive member identification, managing high-cost gene therapies demands integrated infrastructure before the first claim arrives. AscellaOne brings together specialty pharmacy expertise and technology-enabled data visibility so health plans and plan sponsors can build that readiness without constructing it from the ground up. When cost, clinical policy, and operational workflows connect within a single platform, payers gain the control the pipeline demands.

Payers have managed high-cost specialty therapies for years, but the economics are changing. A growing number of emerging treatments are administered one-time, potentially curative, or both, concentrating years of anticipated treatment costs into a single financial event. That shift changes how payers need to forecast pharmacy spend, evaluate long-term clinical and financial value, and plan for financial exposure well before a claim arrives. AscellaOne brings specialty pharmacy expertise and pharmacy benefit data together in one operating model, giving health plans and plan sponsors earlier visibility into emerging cost exposure and greater control over how they forecast, budget and manage it.

AscellaHealth’s Q2 Specialty & Rare Pipeline Digest summarizes key FDA approvals, regulatory actions, and late-stage pipeline developments across cell and gene therapies, specialty pharmaceuticals, and biosimilars. While the quarterly update provides a detailed view of individual assets and milestones, the broader value for payers lies in understanding how these developments collectively reshape specialty pharmacy economics and benefit design requirements.

As managing the costs of specialty healthcare continues to be a core focus for patients, providers, and payers, transitioning site of care delivery for patients requiring infusion therapy has become a topic of increasing interest.

As access to meaningful healthcare data continues to expand, there is increasing momentum to equip pharmacy HUB services with actionable insights and analytics. These centralized services play a vital role in coordinating patient support, prior authorization, and adherence programs.

Specialty medications now account for over 75% of all drugs in development. These therapies present a forward-thinking approach to treating complex, chronic, and rare diseases, offering hope and potentially life-changing solutions for patients and healthcare providers.

Part 2 of this series expands on previous insights, examines value-based care models and associated payment approaches, and highlights real-world examples of payers and manufacturers successfully implementing these innovative, performance-based strategies.

This two-part series examines the shift from volume-based to value-based contracts in the healthcare industry and the impact this transition has on specialty drugs and cell and gene therapies (CGTs).

Specialty pharmaceutical healthcare is undergoing a transformative shift. To truly transform this landscape, we must prioritize patient-centric solutions that address these challenges head-on and elevate the standard of care.

The specialty pharmaceutical industry continued to experience rapid growth and transformation in 2024. It was a pivotal year that included key milestones in technology, drug development and affordability initiatives, and an increasing emphasis on patient-centered care.

The upcoming year marks a nationwide movement towards more patient-centric, efficient and accessible healthcare, pushing payers to embrace innovative pharmacy benefit strategies that enhance personalized care and drive better outcomes while reducing costs.

Successfully coordinating specialized patient care requires a structured and strategic communication flow across the care continuum to ensure proper access to necessary therapies, promote full adherence to treatment regimens, and personalize guidance and support.

Healthcare expenditures are on an upward trajectory, with projections indicating a rise of 7% to as much as 9% by 2025. To mitigate these increases, payers are exploring innovative strategies to maximize the value of their benefit spends.

In response to the rising cost of specialty medications, which now account for 55% of total US drug spending, payers are refining their patient engagement strategies to prioritize personalized care.