Specialty pharmacies handle many complex tasks. These include checking insurance benefits, getting prior authorizations, reviewing drug use, scheduling medication deliveries, and supporting patients. Data from the 2024 NASP Annual Meeting shows that over 86% of specialty pharmacy groups are working to improve their processes to manage growing demand and fewer resources. More than 69% are thinking about using AI technology to help serve more patients with fewer staff.
AI tools mainly help healthcare workers by doing repetitive, time-consuming work. They do not replace people. For example, AI can help with communications, assist with copay support, use interactive voice response (IVR) systems, and analyze patient feelings in real time. By letting AI handle these tasks, pharmacy staff can spend more time on direct patient care and making clinical decisions.
Specialty pharmacies deal with a lot of sensitive patient information, so keeping data private and secure is very important when using AI. AI systems bring new risks, especially when moving data, controlling who can access it, and encrypting information during updates or system changes. Security problems can lead to data breaches. These breaches can violate strict laws like HIPAA and SOC II.
Some best practices for keeping AI data safe include:
Many healthcare groups use special tools like Censinet RiskOps™ to watch over AI vendors and check their security regularly. These tools help track vendors’ security measures, show compliance in real time, and report on changes and risks from sub-vendors. Censinet uses a mix of automation and expert review for better control.
Watching vendors closely is important because many specialty pharmacies do not have AI cybersecurity experts in-house. They depend on third-party vendors to provide software. Without strong control, vendor risks can affect clinical work.
Bias in AI is a big challenge in healthcare, including specialty pharmacies. Bias happens when AI is trained on data sets that do not fairly represent the patients served or have errors. This can cause wrong recommendations, uneven quality of care, and ethical issues that hurt patient trust.
Specialty pharmacies must keep checking and fixing bias. This includes:
AI should be clear and responsible. Pharmacy leaders must ask vendors to follow guidelines for reducing bias and teach staff how AI works to build trust.
Choosing the right AI vendor takes careful thought. Specialty pharmacies should evaluate vendors by considering:
Outside partners are helpful since most specialty pharmacies do not have enough resources to build strong AI teams. Vendors provide AI experts, infrastructure, and the ability to grow that is hard for small groups to get alone.
Bringing AI into specialty pharmacies means managing changes in staff and processes carefully. People may resist new technology, not get enough training, or find that workflows do not fit well with AI tools.
The Human-Organization-Technology (HOT) framework explains challenges like these:
Leaders can handle these problems by:
AI automation helps improve specialty pharmacy workflows by cutting down manual work, speeding up admin jobs, and making patient interactions better.
Some workflow areas helped by AI automation are:
These automated steps free pharmacy staff from time-consuming admin work. Also, AI systems often use human-in-the-loop designs, meaning pharmacists or admins check AI decisions when things are unclear or flagged. This teamwork improves accuracy and helps clinicians trust AI.
Healthcare workers like Rachel Clifton say AI is useful for handling boring, repetitive tasks. It lets staff spend more time giving direct clinical care and personal patient attention.
Medical practice administrators and IT managers working with specialty pharmacies in the U.S. should keep several points in mind when planning AI use:
Not dealing with these issues can cause staff pushback, data problems, or AI use that hurts rather than helps patient care.
AI technology can help specialty pharmacies in the U.S. work better, make workflows smoother, and serve patients with complex needs more effectively. But to get these benefits, it is important to think carefully about key issues:
By focusing on these points, medical practice administrators, pharmacy owners, and IT managers can use AI safely and well in specialty pharmacies. This leads to better, safer care while following complex U.S. healthcare rules.
Specialty pharmacies face a shortage of human capital and aim to do more with fewer resources. AI helps transform patient experiences by automating manual and administrative tasks like verifying benefits and managing prescription follow-ups, ultimately serving more patients efficiently.
They should begin with a well-defined, high-impact problem that can be addressed with a relatively simple AI application. Examples include streamlining communications, medication delivery scheduling, benefit verification, and prior authorization management.
AI supports streamlining communications, medication delivery scheduling, enhancing customer service, pharmacist education, benefit verification, navigating IVR, drug utilization review, prior authorization, copay assistance, and real-time sentiment analysis.
Challenges include regulatory constraints, ethical concerns, high costs, fear of professional liability (FOMU), lack of in-house AI expertise, data privacy and security requirements (HIPAA and SOC II compliance), data quality issues, and resistance to change within established healthcare processes.
They can use synthetic data or simulated environments to mitigate data quality issues, prioritize education and training for staff, and thoroughly assess AI vendors for compliance with HIPAA, SOC II, bias reduction, and safety guardrails.
Define the specific problem first, ensure vendor compliance with HIPAA and SOC II, check for continuous bias and safety monitoring with human-in-the-loop guardrails, pilot test solutions, minimize operational disruption, and plan for change management to overcome cultural resistance.
AI agents are not perfect and may make errors or hallucinate. Keeping humans in the loop ensures performance monitoring, error correction, and continuous learning. Humans intervene when AI encounters uncertainties, improving accuracy and safe automation.
External partners provide access to specialized talent and scalable infrastructure, enabling faster, safer, and more cost-effective AI deployment. They also support continuous adaptation and compliance, which many specialty pharmacies may struggle to achieve alone.
AI agents automate tedious, time-consuming tasks like verifying benefits or following up on authorizations, freeing healthcare workers to focus on patient care. It is designed to augment—not replace—human efforts, creating greater overall efficiency and effectiveness.
They must ensure AI solutions are bias-free through regular testing and correction, maintain patient privacy via HIPAA and SOC II compliance, and uphold transparency. Ethical AI respects patient safety and the professional integrity of providers, preventing harm or misinformation.
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