The Growing Challenge of Specialty Pharmacy Access

An estimated 133 million Americans are currently suffering from a chronic illness, such as hypertension, heart disease, and arthritis. That’s nearly half the population. It’s likely that someone close to you is silently navigating life with a chronic condition and potentially suffering from the effects of that condition every single day. In addition to the pain and disruption that chronic conditions often create, another troubling side effect of these conditions is the ever-growing challenges around specialty pharmacy access.

Specialty pharmacy refers to the distribution and management of costly, complex, and frequently used therapies, typically used to treat chronic, rare, or complicated conditions. Specialty pharmacy is similar to specialty treatments, which GTSN has covered in a previous blog post. As rising healthcare costs are being felt across the board—specialty pharmacy is no different. This means the barriers to accessing these medications are also increasing for those who need them most.

Imagine living with pain, fatigue, and weight loss due to an autoimmune disease like rheumatoid arthritis, which attacks the lining of joints and often brings an onslaught of painful symptoms. Now, imagine knowing that a medication exists that could ease your suffering or slow the disease’s progression, but it’s out of reach because it isn’t covered by your insurance and is difficult to access. That is the reality for millions of Americans living with chronic illnesses.

Golden Triangle Specialty Network (GTSN) aims to ease the suffering of those affected by specialty pharmacy access by bringing a unique, provider-aligned perspective, streamlining the path to therapy, and improving the lives of patients and providers.

 

The Pain Points: Where Access Breaks Down

Accessing medication is already a challenging process, but for those who require specialty medications, the process is even more complex. There are many reasons for this, but some key factors include:

• Overcomplicated authorization processes significantly slow the process of giving and receiving treatment.
• Limited distribution networks restrict where and how patients can obtain the medications they need.
• Formulary exclusions can prevent patients from receiving the most effective treatment options, even when prescribed by their provider.

In addition to these general challenges, self-funded providers are subject to even more barriers that affect access to specialty pharmacy medications. Unlike large national carriers, they often lack the negotiating power needed to influence pharmacy benefit design or secure better pricing. Many are reliant on third-party pharmacy benefit managers (PBMs), whose contracts frequently include restrictive terms and limited transparency. This reliance, combined with significant variability in drug pricing and access, makes it more difficult to ensure members receive timely and affordable care.

 

The Supply Chain Squeeze

The specialty drug supply chain is highly sensitive to disruption. Global events, like pandemics and geopolitical instability, can cause a shortage of raw materials needed for drug manufacturing. Many specialty medications also require cold chain storage, which involves strict temperature control, which adds another layer to the already-complex system. Furthermore, manufacturers often limit the number of distribution partners they work with, which can create bottlenecks when demand spikes or supply is interrupted.

Changes in global trade policies can have a direct impact on specialty drug access and affordability as well. Tariffs and import/export restrictions can increase the cost of medications, driving up prices for patients.

All these moving parts quickly add up, reducing availability and delaying access to necessary therapies. For health plans and providers already managing a constrained supply chain, these factors add extra uncertainty and cost.

 

GTSN: Navigating Through Troubled Waters

GTSN takes a unique approach to solving common specialty pharmacy access challenges. As an independent organization, GTSN can operate without the conflicts that often come with being tied to PBMs or drug manufacturers. This freedom allows us to prioritize what matters most: timely, cost-effective access to high-quality care. With the flexibility to source medications from a broad range of partners, GTSN can respond quickly to supply chain and cost disruptions without compromising the member’s experience.

 

A Better Path Forward for Self-Funded Plans

As specialty pharmacy medications become more of a need for many Americans, self-funded health plans must find solutions to balance access, affordability, and quality of care. At GTSN, we serve as a trusted partner to help you traverse this complex landscape. GTSN helps health plans take back control of their specialty drug strategy by reducing administrative friction, increasing speed to therapy, and improving affordability.

Flexibility and independence are what set us apart. In a world where access to specialty medications can be delayed or denied due to rigid systems, GTSN brings a responsive, patient-first model designed to work for plans of all sizes.

Now is the time to take a smarter, more agile approach to specialty pharmacy. Connect with GTSN today to discover how your plan can benefit from a partner that puts your needs and your members first here.