Evaluating the impact of specialty pharmacies on access to biologics in patients with moderate-to-severe asthma

Objective: To evaluate whether specialty pharmacy use reduces delays from biologic prescription to insurance approval and administration in patients with moderate-to-severe asthma. Methods: We conducted a retrospective cohort study of patients prescribed asthma biologics in the Bronx, New York. Cohorts were defined by time period: before specialty pharmacy implementation (2017–2020) and after (2020–2023). Primary outcomes were time from prescription to insurance approval and administration. Wilcoxon rank-sum tests compared groups, and multivariable regression models adjusted for covariates. Results: 340 patients were included (pre-implementation = 259; post-implementation = 81). Median prescription-to-approval time decreased from six days (IQR 1–20) to two days (IQR 1–8; p =.003). In adjusted analyses, specialty pharmacy use was associated with higher odds of approval within 14 days (OR = 2.67, 95% CI 1.33–5.69, p =.008), though the Cox model was not significant (HR = 1.30, 95% CI 0.95–1.77, p =.10). Median prescription-to-administration time decreased from 34 days (IQR 18–65) to 24 days (IQR 15–36; p =.113). Specialty pharmacy use was not significantly associated with faster administration in Cox models (HR = 1.04, 95% CI 0.73–1.49, p =.82), but showed a borderline association with administration within 30 days in logistic regression (OR = 1.78, 95% CI 0.99–3.27, p =.057). Conclusions: Specialty pharmacy implementation significantly accelerated approval and showed a trend toward faster treatment initiation. Delays in administration persisted despite adjustment for patient-level factors, underscoring the role of other barriers. Larger, multi-center studies are warranted.