Specialty Pharmacy Faces Gaps in Payment, Data, and Patient Trust

At NASP's inSPire2026, speakers returned to one theme: specialty therapies are advancing faster than the payment, data, and trust infrastructure around them.

Specialty therapies are becoming more durable, more personalized, and more expensive, but the systems built to pay for them, track them, and keep patients on them are still catching up. That gap was a recurring thread at inSPire2026, the National Association of Specialty Pharmacy's newly rebranded annual meeting, held September 22-25, 2026, in National Harbor, Maryland. Across sessions on cell and gene therapy payment, 340B, clinical trials, and artificial intelligence (AI), speakers kept arriving at the same conclusion: specialty pharmacy is closest to the patient, but the infrastructure around it hasn't caught up.

Paying for One-Time Therapies

Nearly 10 years after CAR T-cell therapies reached the market, Medicare still has no durable way to pay for cell and gene therapies, leaving hospitals to absorb costs once temporary add-on payments expire, according to Dan Farmer of BGR Group.¹ Value-based deals meant to ease that burden have also stalled amid regulatory changes and fragmented data. Tay Salimullah, founder of Renovamen Advisors, argued that outcomes guaranteed for these therapies are inevitable.²

“Better to embrace it,” Salimullah said, “and make sure we get these therapies to patients who desperately need them.”

340B Finds Common Ground

In a structured 340B debate, Mark Ogunsusi, PharmD, JD, of K&L Gates, argued the covered-entity position, and Josh Weber, PharmD, MBA-HCM, argued the manufacturer side.³ Weber pointed to the program's rapid growth, with 340B purchases reaching $100 billion in 2025. Ogunsusi countered that 340B hospitals provide a disproportionate share of the nation's uncompensated and Medicaid care.

Despite arguing opposite sides, both landed on the same fixes: an independent data clearinghouse and a statutory definition of a 340B patient.

Putting Pharmacy's Patient Contact First

Specialty pharmacies track every dose and refill, but that patient contact often goes unused. On a clinical research panel, Tina Valbh, BSPharm, PhD, of PharmaKonnect, noted that few pharmacies ask patients whether they're enrolled in a clinical trial, a single question that could open a line to trial sites.4

MS care has a similar gap. Pharmacies check in with patients between neurology visits, yet a narrative review found no existing patient-reported outcome tool fits the pharmacy workflow.⁵ When pharmacists do have a clear role, the payoff shows: at the University of Virginia, pharmacist-coordinated switching to subcutaneous ocrelizumab could free 883 infusion chair-hours a year across 100 patients.⁶

Fireside Chat With “Dr G”: AI and Trust

The conference closed with a fireside chat with Geeta Nayyar, MD, known as "Dr G," a rheumatologist, former chief medical officer for Salesforce and AT&T, and author of Dead Wrong. She cautioned leaders against chasing polished AI demos that ignore how care actually works.

"The health care industry is single-handedly keeping the fax machine industry alive," she said.

Instead, Nayyar said, organizations should ask their staff for their top 5 problems between prescription writing and prescription taking. The repetitive tasks can be automated. The nuanced moments, like a denied prior authorization or an adverse effect, still need a person. That human connection, she argued, is where trust lives. Patients may distrust health care institutions, but they still trust their pharmacist, nurse, or physician.

"What you do is truly the difference between life and death," she said. "So do it well. Do it bold."

References

1. Atta H. Nearly a decade after CAR T, Medicare's cell and gene therapy payment gap persists. AJMC^®. September 23, 2026. Accessed September 30, 2026. https://www.ajmc.com/view/nearly-a-decade-after-car-t-medicare-s-cell-and-gene-therapy-payment-gap-persists
2. Atta H. Reimagining value-based deals through risk-pooling models. AJMC. September 25, 2026. Accessed September 30, 2026. https://www.ajmc.com/view/reimagining-value-based-deals-through-risk-pooling-models
3. Atta H. Opposing sides of 340B debate converge on data clearinghouse, patient definition. AJMC. September 25, 2026. Accessed September 30, 2026. https://www.ajmc.com/view/opposing-sides-of-340b-debate-converge-on-data-clearinghouse-patient-definition
4. Atta H. Lack of patient support in specialty pharmacy clinical trials. AJMC. September 23, 2026. Accessed September 30, 2026. https://www.ajmc.com/view/lack-of-patient-support-in-specialty-pharmacy-clinical-trials
5. Atta H. Specialty pharmacies see patients with MS often but lack the right tool to measure decline. AJMC. September 24, 2026. Accessed September 30, 2026. https://www.ajmc.com/view/specialty-pharmacies-see-patients-with-ms-often-but-lack-the-right-tool-to-measure-decline
6. Atta H. Switching to subcutaneous ocrelizumab for MS could free 883 chair hours in a year. AJMC. September 24, 2026. Accessed September 30, 2026. https://www.ajmc.com/view/switching-to-subcutaneous-ocrelizumab-for-ms-could-free-883-chair-hours-in-a-year