Use AI to transform your health system’s specialty pharmacy
Join us for the latest in our series, AI in healthcare. Learn how AI can make a positive impact on different areas of pharmacy. Written by William Riley, VP, Commercial Analytics.
Artificial intelligence (AI) is reshaping the healthcare landscape, offering new opportunities to address some of the most complex challenges in specialty pharmacy. For health systems that operate specialty pharmacies, AI provides transformative capabilities to enhance patient care, improve operational efficiency, and expand financial sustainability. By leveraging these advancements, hospital-owned specialty pharmacies are well-positioned to drive innovation in value-based care, optimize the benefits of the 340B program, and achieve meaningful improvements in both outcomes and access.
Streamlining operations and improving efficiency
Hospital-owned specialty pharmacies handle high-cost medications, intricate treatment regimens, and complex payer landscapes. AI tools are proving invaluable in streamlining these processes. Predictive analytics optimize inventory management, ensuring the right medications are available without overstocking or waste. Similarly, machine learning algorithms are expediting prior authorization workflows, reducing administrative burdens, and accelerating time-to-therapy for patients.
AI also enhances revenue cycle management by identifying overlooked reimbursement opportunities and improving billing accuracy. For health systems, this translates to increased financial sustainability while continuing to meet patients’ needs effectively. As the demands on specialty pharmacies grow, operational efficiencies driven by AI are becoming essential to maintain quality and scalability
Elevating patient care and outcomes
The integration of AI into clinical workflows allows specialty pharmacies to enhance patient care in ways previously unattainable. Using data from electronic health records (EHRs), AI can identify patients at risk of nonadherence, adverse events, or suboptimal treatment outcomes. These insights enable pharmacists to deliver targeted interventions, such as adherence monitoring, tailored education, or adjustments to therapy based on predictive models.
Natural language processing (NLP) tools and AI-driven chatbots are revolutionizing patient engagement by providing timely, accessible communication. These technologies help patients manage their medications, answer questions, and adhere to prescribed therapies, all of which contribute to better clinical outcomes. For health systems, this level of engagement not only improves individual care but also strengthens the broader institutional mission of delivering high-quality, patient-centered services.
Driving value-based care
AI is a powerful enabler of value-based care, a model increasingly embraced by health systems. By analyzing large datasets, AI can quantify outcomes, measure quality metrics, and assess the total cost of care for specialty therapies. These insights support health systems in negotiating value-based contracts with manufacturers and payers, aligning reimbursement with clinical outcomes rather than volume alone. AI also allows hospital-owned specialty pharmacies to identify high-risk patients and stratify them for proactive, cost-effective interventions. This approach reduces avoidable hospitalizations and emergency visits while improving overall patient outcomes. As a result, AI not only enhances care but also strengthens the financial case for value-based models.
Expanding the 340B program
For health systems, the 340B Drug Pricing Program represents a critical opportunity to enhance both access and financial performance. AI tools can analyze prescribing patterns, ensure compliance, and streamline audit processes, maximizing the benefits of the program.
AI also enables hospitals to identify underserved patient populations and expand their 340B footprint. With the savings realized through optimized 340B operations, health systems can reinvest in community programs, improve access to specialty care, and fund critical health initiatives.
The future of AI in specialty pharmacy
Looking ahead, the role of AI in hospital-owned specialty pharmacies will only expand. Advances in precision medicine, digital therapeutics, and generative AI are poised to transform how rare and complex diseases are treated. As these technologies integrate further with EHR systems and care coordination platforms, hospital-owned specialty pharmacies will become even more central to institutional efforts to improve outcomes and reduce costs.
For health systems, the strategic adoption of AI is not merely an operational upgrade—it is a critical investment in the future. By embracing AI-driven innovation, specialty pharmacies can deliver superior care, align with value-based care goals, and unlock the full potential of programs like 340B. In doing so, they will not only improve patient lives but also strengthen the long-term sustainability of healthcare delivery.
Final thoughts
Artificial intelligence represents a pivotal opportunity for health systems to reimagine the role of specialty pharmacy, leveraging technology to advance both institutional goals and community health. It is a transformation that is as inevitable as it is necessary—and the time to act is now.
Further reading
- Use AI to optimize your health system’s 340B program
- A look forward: Outlook and insights for health systems in 2025
Learn more
Curious how Maxor can help you improve the value of your pharmacy? Contact us by filling out the form below.
