Specialty medications, the high-cost therapies that demand special handling, monitoring, or administration training, now claim at least half of U.S. pharmaceutical spending while treating fewer than 5% of patients. That imbalance is set to widen: roughly 75% of the 7,000 drugs in development are specialty products.

Getting those therapies taken is a different problem from inventing them. Nearly two-thirds of prescriptions for newly launched drugs go unfilled in the first year on the market, according to IQVIA Institute research, and patients paid a record $110 billion out of pocket for medicines in 2025. Every abandoned prescription converts a scientific success into a clinical failure.

Jocelyn Freimuth has spent her career inside that delivery gap. A board-certified sterile compounding pharmacist with a Doctor of Pharmacy, MBA, and nursing credentials, she worked in geriatric and dementia care before pharmacy school and built a compounding practice in Nashville. She now serves as a professor at the University of Tennessee Health Science Center College of Pharmacy and leads Camino Compass, a consulting firm advising pharmacies nationwide on specialty operations, compounding compliance, and accreditation readiness. Her answer to the abandonment problem is a role she calls the care connector, a framework she presented to an international pharmacy audience this year, and her argument runs simply: specialty pharmacists are the connective tissue between a written prescription and a treatment outcome.

Why do specialty prescriptions stall after they’re written?

A specialty prescription passes through seven stages before anyone can call it a success: prescribed, approved, received, started, monitored, continued, assessed. Jocelyn Freimuth’s framework maps a distinct failure mode to each stage. Coverage delays stall the approval. Storage confusion complicates the handoff, while side effects, missed follow-ups, and refill gaps erode everything after the first dose.

Complexity runs on both sides of the counter. Specialty products often require cold-chain storage, injection training, and scheduled lab monitoring. Patients bring their own load: cost anxiety, low health literacy, comorbidities, and the long-term adherence demands of chronic disease. Three questions surface again and again in her patient-journey model: can I get this medication, do I know how to use it, and who helps me if something goes wrong?

Each stage of the journey carries its own job on her map. Review needs when the prescription lands, remove barriers during approval, build confidence through education, start therapy on time at delivery, monitor closely through follow-up, and sustain the result over years. Small problems stay small, she argues, when someone owns the touchpoints between stages.

The High-Touch Label, Earned

High-touch is the industry’s term for this category, and it understates the work. A biologic that needs refrigeration, device training, and quarterly labs cannot succeed on a standard dispensing workflow. Neither can a frightened patient facing a four-figure copay and an injection they have never given themselves.

The care connector framework Jocelyn Freimuth teaches

Traditional pharmacy metrics ask one question: was the medication dispensed? Jocelyn Freimuth swaps it for five. Could the patient access the therapy, understand it, tolerate it, continue it, and benefit from it? A fill that fails any of those tests counts as unfinished work.

Her framework organizes the connector role into four moves:

  • Identify: find clinical and social barriers before they interrupt therapy
  • Connect: engage prescribers, nurses, access teams, and payers around defined roles
  • Support: guide the patient from first dose through long-term use, with education built to prepare rather than merely inform
  • Measure: track access, safety, adherence, and progress as outcomes, not transactions

Education gets the most specific treatment in her model. Before a first dose, a patient should be able to answer five things: why this therapy, how to take it, what to expect, what to watch for, and who to contact when something changes. Patients who can answer all five start sooner and stay on therapy longer, which is why she frames teaching as preparation rather than information transfer.

That advocacy instinct predates Jocelyn Freimuth’s pharmacy career. She built patient charts as a young nurse and taught herself the medication therapies behind them, watching communication gaps open between prescribers and nursing staff. “The patients I remember are the ones who could not speak up for themselves. Everything we build is designed so they never have to,” she says.

What coordination asks of the care team

Interprofessional care sounds like a platitude until someone specifies the mechanics. Jocelyn Freimuth’s version names five requirements: shared goals, defined roles, open communication, timely follow-up, and measured outcomes. Remove any one of them, and the patient becomes the courier between their own providers.

Her conference case study makes the mechanics concrete. A patient new to specialty therapy arrives worried about side effects, unsure how to start, with baseline labs outstanding and no follow-up plan. Pharmacist actions map to each barrier: a pricing review answers the cost question, plain-language education replaces confusion, coordinated lab scheduling clears the monitoring hurdle, and a proactive check-in catches refill risk before a gap opens. Before support, the file reads delayed start, unanswered questions, and discontinuation risk; after it, faster start, clear plan, and early monitoring.

Payoffs are distributed across the system when the loop holds. Patients report better understanding and stay on therapy longer. Care teams field fewer complications, and health systems shed administrative burden while gaining outcomes data they can act on.

Competency as the Bottleneck

Coordination also depends on the technical floor holding. Freimuth led a June workshop in Nashville that trained 64 qualified evaluators, the personnel who certify compounding competency, across four functioning cleanroom stations. “We often talk about training compounders, but rarely do we talk about training the people who determine competency,” she said in the event’s announcement.

From one patient to public health

Repeated barriers are diagnostic. When the same coverage delay or counseling failure shows up across dozens of patients, the problem stops being individual and starts being structural. Jocelyn Freimuth’s framework treats those patterns as population signals: fixing one recurring barrier improves access, safety, and adherence for every patient behind it.

Equity enters through the same door. Language, distance, technology gaps, and fragmented care decide who benefits from a therapy as surely as biology does. Plain-language education, resource navigation, and scheduled follow-up are unglamorous interventions with population-level returns, and they sit squarely inside the pharmacist’s reach.

Affordability work belongs on the same list. Transparent upfront pricing, simple enrollment, and flexible payment options sound like retail details, yet each one shortens the distance between prescription and first dose. A patient who understands the cost before committing rarely abandons the fill at the counter.

On top of her time at Camino Compass, she also spends time training the evaluators who will police the field’s technical standards. Jocelyn Freimuth’s reframe, carried from nursing stations to cleanrooms, stays constant: a dispensed medication is a transaction, and an outcome is the point. Half of the country’s drug spending now depends on whether someone does that connective work for fewer than 5% of its patients.

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