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What are Specialty Pharmacies and How Do They Work?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on July 16, 2024.

Maybe you’ve noticed: medications are getting more complicated, more personalized, and more expensive.

Look at some of the recent drugs approved for cancer, hepatitis C virus, or rheumatoid arthritis. These are three very different conditions, but many newer drugs used to treat these conditions have common traits:

What is a specialty pharmacy?

As noted by the American Pharmacists Association, a specialty pharmacy provides distribution of specialty, high cost medications. There is also a high-touch and patient-centered management system to positively benefit the patient’s experience.

Patients receiving these medications require a significant degree of continuous patient education, ongoing monitoring, and medication management by skilled pharmacists. Ideally, this improved care model leads to measurable, positive clinical outcomes for the patient and healthcare system.

You should have the right to understand and make informed decisions about your medications -- the pros and cons -- as well as important cost issues. These are all areas a specialty pharmacy can help you understand, but many patients are confused about these services and exactly how they work.

Here's a few questions you might have:

A specialty pharmacy is usually a subset of a larger health insurance provider, retail provider, or pharmacy benefit manager (PBM) that coordinates these services, although independent specialty pharmacies also exist.

Examples of some the top Specialty Pharmacies in the U.S. include:

These pharmacies may not be located in your town, or even in your state, but you can easily contact them on the phone or by email. Increasingly, specialty drugs can be dispensed from your local pharmacy, but not always. A specialty pharmacy works closely with you - the patient - to provide a personalized plan of care to optimize your medical outcomes and safety.

Your medications may be mailed to you so you can get them safely and on time. Even medications that require refrigeration can be shipped with a cold pack. Supplies, such as syringes, alcohol swabs, and sharps kits, if required, may be supplied as well as overnight express mail service. Online access to your pharmacy profile is available.

A pharmacist or nurse will initiate follow-up care to remind you when it is time to refill your prescription, check on your therapy progress, and answer your questions to help you with your treatment. 

What medical conditions are covered by a specialty pharmacy?

Common chronic, conditions that a may be covered for specialty pharmacy care include:

Individualized education is at the forefront of specialty services to be sure you feel comfortable and understand your medication. Often, you as the patient will be teamed up with a care coordinator that can answer your questions about your medication, provide disease education, and even help you research payment for your medications when you cannot afford them or your insurance does not fully cover all the costs.

Your care coordinator will work closely with your doctor to be sure your medication and dose are appropriate, screen for drug interactions, monitor for side effects, and be sure that refills are shipped in a timely manner. Unnecessary costs can be avoided and professionals will work on your behalf to make sure you can take your medication without fail.

What is a specialty drug?

Specialty-type drugs have been growing rapidly over the last few decades. These drugs are FDA-approved to treat complex medical conditions and rare diseases, are often very expensive and require special storage, preparation, and handling. They can be taken orally, injected, inhaled or given by infusion.

As new information is learned about diseases, novels drugs like biologics, targeted therapies, and personalized medicine will expand. Many of these new therapies are prolonging survival for patients or increasing their quality of life.

These drugs also continue to get more and more expensive, often to the point where someone without insurance coverage cannot afford them. However, there may be options to help you if cost is an issue. Drug manufacturers may provide patient assistance or copay programs to help address high costs.

Most drugs classified as specialty drugs have these criteria:

Examples of drugs often coordinated by specialty pharmacies:

Is there help to pay for specialty medicines?

The cost of specialized medications is often a shock for patients. For example, the antiviral hepatitis C medication called Sovaldi (sofosbuvir) costs roughly $1,000 per pill, taken once daily over a 12-week or 24-week period. This can quickly add up if you do not have insurance coverage. Plus, it is taken with at least one other medicine.

It’s not unusual for specialty meds to run into the tens or even hundreds of thousands of dollars.

Learn more: 10 of the Most Expensive Drugs in the U.S.

Your specialty pharmacy care coordinator can refer you to a financial assistant that may know of alternative ways to help you pay for your drugs; for example, through a manufacturer’s Patient Assistance Program (PAP) or a state assistance program. The Patient Advocate Foundation may be another source. Call the manufacturer of your drug to learn more about Patient Assistance Programs.

Be sure to ask your health care providers for other sources of financial assistance on high-cost medications that you are unable to afford. These services can lower your out-of-pocket expenses and allow you to take a medication you would otherwise not be able to afford.

If you cannot afford your medications, or have no assistance, have a frank discussion with your healthcare provider about other alternatives or options. They are always glad to offer help and advocate for you in any way possible.

Specialty Drug Revenues 

Specialty pharmacies and drug treatments have become big business. Total U.S. prescription revenues for specialty medicines grew from 24% in 2013 to almost 40% in 2023. For 2023, Drug Channel Institute (DCI) estimated that U.S. prescription dispensing revenues from specialty pharmaceuticals reached $243 billion.

IQVIA estimates that 60% of drug spending in 2026 will involve specialty medicines in developed markets. Globally, specialty medicines will account for 45% of global spending by 2026.

Related: What are biosimilar drugs?

For More Information

See the National Association of Specialty Pharmacy

Sources

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer