Specialty pharmacies help patients with complicated health problems that need special medicines. These involve many steps, like handling insurance papers, getting approval before the medicine is given, and supporting patients over time. These steps take a lot of time and effort from staff, and sometimes slow down patient care because of manual work. Research from the NASP Annual Meeting 2024 shows that over 86% of specialty pharmacies want to improve these processes. More than 69% are looking into using AI to make their work better and help patients more.
AI is useful because it can do repetitive tasks automatically. This lets healthcare workers spend more time taking care of patients directly. AI can check insurance, manage prescription transfers, plan medicine deliveries, and help with programs that lower medicine costs. Even though saving money is important, the main goal is to work better without hurting safety or the quality of care.
Even with the benefits, using AI in specialty pharmacies is not easy. Some of the problems include:
To deal with these problems, human-in-the-loop (HITL) systems have become popular. In HITL, AI handles simple tasks but asks humans to check and make decisions when things are unclear. This helps keep a balance between AI doing work fast and humans making careful judgments.
In specialty pharmacies, this means AI might check insurance benefits automatically. But if it finds unclear or conflicting information, it “raises a digital hand” to alert a human worker. The human then reviews and fixes the issue. This correction also helps the AI learn and improve. This teamwork lowers the chance of mistakes.
Rachel Clifton, who works with AI in specialty pharmacies, says it is important to keep humans involved. AI helps by doing boring jobs so healthcare workers can focus on patients. Humans catch errors AI might miss. They also make judgments that AI cannot handle.
Specialty pharmacies use AI to help with communication and admin work. Some key areas include:
By automating these tasks, AI allows pharmacy staff to spend more time helping patients directly. Specialty pharmacies are open to using AI because it helps them do more with less effort.
Specialty pharmacies must make sure AI follows healthcare laws and ethical rules. Some important points are:
Using fake data and simulated tests can help train AI without risking patient privacy. Training pharmacy workers about what AI can and cannot do is also important for smooth use and good oversight.
Experts suggest that specialty pharmacies first pick specific problems to solve with AI instead of trying to use AI everywhere at once. For example, they might start by automating benefit verification, which is a common slow point. Later, they can add AI to other tasks.
Working with outside vendors who know healthcare AI can help pharmacies that lack in-house AI knowledge. These vendors provide skilled workers, secure cloud systems, and updates to follow changing rules.
When choosing AI vendors, pharmacies should check for:
AI cannot replace human judgment, especially in healthcare. Having humans watch over AI makes patients, doctors, and regulators feel confident that decisions are checked and fixed if needed.
Human-in-the-loop systems keep professionals responsible for care. Pharmacy staff can check AI results, explain choices to patients or doctors, and step in when complex issues happen. This oversight reduces mistakes and stops AI from giving wrong or made-up information.
Infinitus AI, a company at the NASP Annual Meeting, showed how their AI notifies human reviewers when the system is unsure. The AI “raises digital hands” to get staff help. This design helps improve AI over time and keeps work safe.
Infinitus noted that 86% of specialty pharmacies want to improve processes, and 69% are working with AI. Using HITL systems helps these organizations manage rules and risks while getting the benefits of AI.
For those in charge of specialty pharmacies and healthcare in the US, it is important to understand the role of human oversight in AI work. They must balance AI benefits with rules, ethics, and safety needs of healthcare.
Using AI with human-in-the-loop controls can:
By seeing AI as a tool that needs human review, specialty pharmacies can work more efficiently while keeping care quality safe.
This framework helps specialty pharmacies and healthcare facilities across the US match their AI plans with laws and ethical rules. Human oversight stays important to make sure AI helps work the right way without harming patient safety or professional responsibility.
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.
Simbo is using AI agents to automate all phone related workflows. Connect now to know more.
Schedule AI Agents Demo Now© Since 2019, Simbo AI.
