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Specialty pharmacy at Nashville Healthcare Pharmacy reports improving margins after PBM issues resolved
Summary
Pharmacy manager Jeff Hardwick told the Hospital Authority Board the specialty pharmacy has moved from early negative margins to improving profitability after becoming a covered entity and resolving PBM processing problems; the board heard projected profit-margin estimates and plans to reduce patient 'leakage' to outside pharmacies.
Jeff Hardwick, pharmacy manager, told the Hospital Authority Board on Oct. 30 that the hospital’s specialty pharmacy, operating at the Metro Center clinic as Nashville Healthcare Pharmacy, has progressed from initial startup losses to a positive revenue outlook after technical and contractual hurdles were resolved.
Hardwick said the service handles high-cost specialty medications — “pretty much any medication you see on TV” — used in oncology, rheumatology, HIV care and other specialty clinics. He told the board the program was approved almost a year ago and, while early months showed large drug spend, reimbursement eventually covered those costs. “As we were spending all that money…we were reimbursed all that money,” Hardwick said.
The report described two factors that shifted the program’s finances. First, the pharmacy became a covered entity for the 3 40 b program (referred to in materials as “3 40 b”), enabling discount accumulation and later redemption. Second, the team resolved a three-month claim-processing issue with a PBM (Optum), which had prevented filing certain 340B claims. Hardwick said clearing that issue should reduce wholesale acquisition-cost spending and improve margins.
Hardwick acknowledged a revenue-sharing arrangement with a specialty-pharmacy partner, CarePath, which takes 22% of total specialty revenue under the current model. He said the pharmacy’s average script figures and volumes were shown to the board (presentation slide referenced $2,700,000 in script revenue on the chart). Hardwick projected, if current trends repeat, a prospective profit margin in the range of roughly $1.8 million to $2.5 million for the next fiscal year, noting personnel costs for the operation are limited (one pharmacy manager, one part-time pharmacist, one full-time technician).
Board members asked about October spending and reimbursement details; Hardwick replied he would provide more detailed margin and reimbursement numbers to the board. He also emphasized efforts to reduce “leakage” — specialty prescriptions written in the hospital that are instead filled at outside pharmacies — and said retention is at about 81% for prescriptions that entered the system, with an adoption rate of approximately 65% by providers in the EMR. He said the team is pursuing a second accreditation to open access to limited-distribution medications and is working with a pharmacy liaison to increase uptake across clinics.
Hardwick described patient-facing services such as free delivery and accelerated prior-authorization support, and said the pharmacy encourages but cannot require discharged patients to fill prescriptions on-site. He emphasized the program’s dual mission: improving patient access and creating margin to support the hospital’s broader mission of equitable care.
The board thanked Hardwick for the presentation and invited follow-up details on reimbursement margins and payer mix.
