Closing SDOH Gaps in Specialty Pharmacy: Irfana Lakada PharmD, CSP

Prior authorization, benefits investigations, and copay assistance get patients approved for specialty therapies, but they do not guarantee patients can actually take them. In a session at the National Association of Specialty Pharmacy (NASP) inSPire2026 conference, Irfana Lakada, PharmD, CSP, a health equity clinical pharmacist at Shields Health Solutions, argued that specialty pharmacy access workflows often stop at what can be documented, leaving social determinants of health (SDOH) unaddressed.

Transportation problems, food insecurity, unstable housing, and new caregiving duties can keep patients from starting or staying on therapy, even after access is approved. Lakada framed the challenge as moving a patient from approval to the clinical benefit the therapy is meant to deliver, as many barriers surface only in that gap.

Timing matters, she emphasized. Although onboarding seems like the logical moment to screen, it is often when patients are most overwhelmed. They are absorbing information about pharmacy services, dosing instructions, and adverse effects all at once, and few have the bandwidth to disclose sensitive social or financial struggles to someone they just met, Lakada explained.

Instead, specialty pharmacies are better positioned to identify barriers over time. Patients may have more than 35 touchpoints a year with pharmacists and technicians, and each one is a chance to build trust. As rapport develops over months, patients are more likely to speak candidly, which, Lakada said, makes screening more accurate and more actionable.

Rescreening is equally important. A patient who reports no barriers at initiation may later lose a job, have a car break down, or take on caregiving duties that disrupt adherence. When SDOH questions are built into routine follow-ups, teams can respond before a missed refill becomes a discontinued therapy. They can arrange transportation, adjust refill timing, or connect patients with community resources.

The takeaway, Lakada said, is for specialty pharmacies to replace one-time intake screening with a longitudinal, relationship-based approach that treats access as an ongoing process rather than a single approval.