SPRING 2026 I RETAIL/COMMUNITY • SPECIALTY • LTC
26
Q. Specialty pharmacy continues to dominate
healthcare headlines. Why is this segment so
important right now?
Most healthcare leaders don’t realize that 80% of the drugs
in the pipeline are IV-formulations with specialty indications,
and that no pharmacies are getting access to the downstream
oral versions if they can’t prove their capabilities or partner on
launch today. I can’t emphasize this enough for providers that
are still thinking about specialty or infusion — it is existential for
pharmacy survival moving forward. Specialty patients represent
a relatively small portion of the overall population, yet they drive
a disproportionate share of drug spend and resource intensity
across the healthcare system.
That reality changes the stakes. However, I won’t sugarcoat the
reality that it is not easy to compete in this space. Everyday in
this field, small operational breakdowns can create outsized
consequences — lost margin, denied claims, strained payer
relationships, audit vulnerability, limited-distribution access
issues, and stalled growth. At the same time, organizations that
build the right foundation can unlock meaningful enterprise
value. That is why many pharmacy leaders are seeking
experienced guidance early, before complexity turns into costly
rework.
Q. What makes specialty and infusion pharmacy
so different from traditional pharmacy operations?
Traditional pharmacy is often driven by prescription volume
and dispensing efficiency. Specialty and infusion pharmacy are
driven by infrastructure, coordination, and precision. These
models require far more than filling prescriptions well.
Operators must navigate accreditation standards, payer and
manufacturer expectations, multi-state licensure, infusion and
nursing coordination, cold-chain and hazardous shipping
protocols,
clinical
documentation,
prior
authorization
workflows, inventory controls, referral capture, and increasingly
sophisticated reporting requirements. Success depends on
whether these moving parts are built into the operating model
from the beginning. When organizations try to bolt them on later,
growth often outpaces control.
Q. How do experienced consultants help
organizations navigate that level of complexity?
The most effective advisors do more than provide recommendations.
They help organizations translate strategy into execution across
several interconnected areas: operations, financial performance,
regulatory readiness, and market growth.
That may include designing accreditation-ready workflows,
building scalable staffing models, assessing payer and trade
strategy, evaluating service-line expansion opportunities,
strengthening referral conversion processes, supporting multi-
state compliance, and creating practical dashboards that connect
daily performance to long-term financial goals. The best
consulting support is not theoretical. It gives leadership a clearer
roadmap, stronger controls, and measurable improvement in
both revenue performance and risk reduction.
Q. At what stage in a pharmacy or infusion
pharmacy’s growth journey is outside guidance
most valuable?
Usually earlier than leaders think. The need often begins before
launch, during expansion planning, ownership transition,
specialty service-line development, infusion build-out, or entry
into new payer and manufacturer relationships. It also becomes
critical when a pharmacy is preparing for accreditation, scaling
into multiple states, adding nursing or clinical programs,
evaluating technology changes, or trying to improve profitability
without sacrificing compliance.
Many organizations wait until there is a failed audit, payer friction,
margin compression, staffing instability, or referral leakage.
By then, the work is often more expensive and more disruptive.
The strongest outcomes usually happen when leadership brings
in experienced support during key inflection points, while there
is still room to design intentionally rather than react defensively.
Q. What are the most common gaps that hold
specialty and infusion pharmacies back?
A few patterns show up repeatedly. Outside of the reimbursement
pressures and industry dynamics that affect all independents,
one common gap is the lack of alignment between operations
and financial modeling. Another is treating compliance as
a separate function instead of embedding it into workflows,
staffing, training, and reporting. This misunderstanding can lead
to “operational diverticulitis” where credentialing, patient flow,
documentation, inventory, contracting, and quality management
all operate in silos instead of harmoniously.
There is also often a business development gap. Pharmacies
may have strong clinical capability but weak referral strategy,
inconsistent provider engagement, unclear value messaging,
VIC SIMIANU, MBA, PRINCIPAL, FOUNDER AT SPHINX STRATEGIES
QUESTION & ANSWER
SPECIALTY