How Hospital Pharmacies Can Access Restrictive Specialty Networks
By Gina Shaw
As payors and pharmacy benefit managers (PBMs) narrow specialty pharmacy networks, health system pharmacies face increasing exclusion from dispensing high-cost therapies to their own patients. For many organizations, accessing these restrictive networks has become both a strategic imperative and an operational challenge.
Signature Healthcare, a regional health system in southern Massachusetts, addressed this challenge by partnering with Clearway Health, a specialty pharmacy services organization that originated from Boston Medical Center Health System. Clearway Health now collaborates with hospitals nationwide to improve access to care for patients requiring complex, high-cost medications.
Clearway Health embeds board-certified pharmacists and trained pharmacy patient liaisons directly into ambulatory specialty clinics, where they proactively identify patients, assess barriers to care, and coordinate medication access and delivery. This model strengthens medication management, improves adherence, and supports clinical outcomes while helping health systems meet the operational and accreditation standards required for payor network participation.
For Signature, this partnership secured entry into a major regional payor network, overcoming barriers that have historically sidelined hospital pharmacies. “Specialty pharmacies in hospitals face significant barriers to entering access-restricted networks,” said David Young, MLS, BPharm, the vice president of pharmacy operations at Signature Healthcare. “Access to vertically integrated payor networks—particularly large national payors and PBMs—is critical to program growth.”
The Challenge of Vertical Integration
Vertical integration, in which PBMs align with payor-owned specialty pharmacies that control network participation, represents the core challenge, said Robert Pullano, BSPharm, the director of specialty pharmacy operations at Clearway Health. “Health system pharmacies are often overlooked in this process. Networks prioritize their own pharmacies to fulfill prescription needs rather than allowing health system specialty pharmacies into their networks.”
Although payors frequently cite operational concerns when excluding hospital pharmacies, Mr. Pullano noted these explanations often mask addressable challenges. “In my experience, the barriers are more operational than strategic. Health systems can manage these operational challenges when they have the appropriate resources.”
For Signature, limited network access resulted in fragmented care and lost continuity. Prescriptions written within the system often required external fulfillment, creating friction for patients and providers. The financial implications were equally significant. “More than half of our prescription volume consists of specialty medications,” Mr. Young said. “Network access is critical to our mission and program growth.”
Prior to engaging Clearway Health, Signature identified several obstacles to network entry: accreditation requirements, siloed internal workflows, and limited analytics to demonstrate performance capability.
Clearway Health’s expertise helps systems navigate these requirements efficiently. “We have a dedicated team focused on helping health systems secure access,” Mr. Pullano said. “We can address complex 50- to 60-page applications because we understand health system capabilities comprehensively.”
From Transactional to Strategic
Throughout the network application process, Signature’s pharmacy leadership aligned stakeholders across inpatient, ambulatory, and 340B operations—areas that typically function independently. “Medical and pharmacy benefits usually exist in separate silos,” Mr. Young explained. “Convening key stakeholders and mapping the various pathways for retaining patients within our system was essential.”
This coordination elevated the specialty pharmacy program from a departmental initiative to an enterprise-wide strategy. “We transitioned from a transactional model to a strategic system-wide initiative,” Mr. Young said. “This couldn’t be viewed solely as a pharmacy department project.”
This shift is essential for success in restrictive payor environments, according to Mr. Pullano. “The most important objective is a health system’s ability to treat and serve their own patients from a pharmacy perspective. That’s the foundation of the integrated care model.”
Securing network access enabled Signature to retain prescriptions that previously flowed outside the system, strengthening provider relationships and improving patient continuity.
For hospital and health system pharmacies confronting similar barriers, both Mr. Pullano and Young emphasized preparation and persistence. “The biggest misconception is that network access is unattainable,” Mr. Pullano said. “It’s challenging, but absolutely achievable.”
Mr. Young encouraged pharmacy leaders to reframe payor access as a strategic growth opportunity. “You must think strategically rather than viewing payor access as an insurmountable barrier,” he said. “If you have confidence in your program, your team, and your partnership with organizations like Clearway Health, you must believe in your capacity for growth.”
Beyond revenue and market share, Mr. Pullano stressed the clinical imperative. “The most compelling reason to pursue network access is that patient outcomes improve significantly under an integrated model. Failing to prioritize this puts patients at risk.”
The sources reported no relevant financial disclosures beyond their stated employment.