Better Outcomes Start Here: Why Prescription Routing Matters in Specialty Care

New research highlights a growing gap in care and what employers can do about it

For employers, specialty drug spend is often the fastest-growing line item in the health plan, but cost is only part of the story.

A more urgent issue is emerging beneath the surface. Patients are not starting the medications they are prescribed. In specialty pharmacy, that gap carries real consequences.

Why are patients not starting specialty medications?

Recent research published in the Journal of Managed Care & Specialty Pharmacy found that patients are significantly more likely to never start treatment when their prescriptions are routed to pharmacies outside the health system. Plus, they are also more likely to experience delays when they do begin therapy.

This is not a small operational detail. It is a structural issue that directly impacts patient outcomes.

When prescriptions move outside the health system, the connection between patient, provider, and pharmacist becomes fragmented. Prior authorizations take longer. Financial assistance is harder to coordinate. Communication breaks down. In many cases, the provider loses visibility into whether the patient ever received the medication.

The result is predictable. Patients fall off therapy before it begins.

What changes when prescriptions stay within the health system?

By contrast, health system specialty pharmacies operate as part of the care team. They have direct access to clinical information, can navigate approval requirements more efficiently, and stay connected to both the patient and the prescribing provider.

The same study showed that patients using these integrated models are more likely to start therapy and do so more quickly.

That’s why prescription routing matters. Specialty medications are often prescribed for complex, chronic, or life-threatening conditions. Delays in treatment can lead to disease progression, avoidable complications, and higher downstream costs.

As Rourke Yeakley, Chief Medical Advisor at Rescription, explains:

“More than 50% of medications prescribed for chronic conditions are not taken as directed, a gap that contributes to poorer outcomes, higher healthcare costs, and increased risk of complications. Evidence shows how patients access their medications matters. In a recent study published in the Journal of Managed Care & Specialty Pharmacy, patients who fill prescriptions through health system specialty pharmacies are more likely to initiate therapy and do so sooner than those using non-health system pharmacies. This reinforces Rescription’s commitment to partnering with health systems to ensure our patients receive timely, coordinated access to the therapies they need.”

What does this mean for employers and brokers?

For employers and their advisors, this raises an important question: If the goal is to improve outcomes and control costs, why are so many specialty prescriptions still being routed away from the health system?

Traditional models often prioritize network arrangements and contracting structures over patient access. Prescriptions are directed to external specialty pharmacies that may not be connected to the care team. While these models are designed to manage distribution, they can introduce barriers that delay or prevent treatment.

How does Rescription improve specialty drug access?

Rescription takes a different approach. By aligning with health system specialty pharmacies, Rescription helps employers ensure that members can access their medications in a setting that supports faster initiation, better coordination, and improved adherence. This approach is designed to reduce friction at every step, from prescription to actually starting the treatment.

It also creates a more transparent model for employers. Instead of relying on fragmented pathways, employers gain visibility into how medications are accessed, how quickly patients start therapy, and where delays occur. This is where cost and outcomes begin to align.

When patients start therapy sooner and stay on treatment, avoidable complications decrease. That translates into fewer hospitalizations, lower total cost of care, and a better experience for members navigating complex conditions.

The Takeaway for Employers

The takeaway is simple: Where a prescription is sent is not just a routing decision, but a clinical and financial decision.

For employers looking to improve specialty drug performance, it is worth taking a closer look at how that decision is being made today and whether it is truly working in the member’s best interest.

If this issue is showing up in your population, it may be time to rethink how specialty medications are accessed.