Aren’t They All the Same? The Truth About Specialty Pharmacies

You’ve likely heard about specialty pharmacies, but what exactly are they and what services do they provide?

By Susan B. Sloane, BS, RPh, CDE

As a pharmacist, I get frequent questions from patients about prescriptions that come from what are known as “specialty pharmacies.” Most people have one place where they get the majority of their prescriptions. Certain medications, however, cannot be purchased or filled at your neighborhood pharmacy. They need to be ordered through what are known as specialty pharmacies and can be delivered by mail to your door, to the doctor’s office, or in some cases, can be sent to your local pharmacy for pick-up.

The specialty pharmacy that you have is often assigned to you by your own health insurance company. The healthcare provider writes a prescription for the specialty drug, and the drug company generally forwards the information on to the appropriate specialty pharmacy.

Now you may ask, so what is a “specialty” drug, and what makes them different from other routine medications. Specialty products are newer drug entities that are sometimes called biologics. They are often injectables and they require special handling and oftentimes education for the patients if they are to be administered by the patient themselves. The handling of these drug products must be done with care; they need to be packaged and remain at certain temperatures to protect the drug product from being altered or damaged. Drugs made from living organisms, such as vaccines, for example, need to be shipped under very controlled conditions to ensure their effectiveness and safety.

Once your doctor orders a drug product in the specialty category, you will generally receive a call from your assigned pharmacy to let you know your product is being shipped. If the product comes to your home, you may be told you will be administering the drug yourself. Since the products are often injectables, education is needed for the proper injection technique and storage and handling.

If you will be self-administering an injection, many drug companies have educators/healthcare professionals who will do a face to face instructional session with you so that your first injection goes smoothly. A company representative will call you to see if you have the medication, and set up a training, either in person or via computer for a “virtual” training. Keep in mind that the trainer will not be bringing the prescription; you will need the drug before the trainer can come for a home visit.

This all may sound confusing, and it can be because these products are new drugs, and most people are not used to this kind of set up. Keep the name of your specialty pharmacy handy and call with any questions or concerns. One of the first things you will want to ask is the price of the medication.

These drugs are typically very costly, though most are covered by insurance. You will need that information up front. If you are told your prescription is not covered under your insurance plan, you will need to call your insurance company and see what steps you can take to get the drug approved. This is called a prior authorization process and will be initiated by your doctor once you find out a drug is not covered. The physician or provider office will provide the insurance company with valid reasons why you need the medication (they may require blood work or proof of trying another mismatch). Once approved, the drug will ship, and you will pay the co-pay assigned to you by the insurer.

Remember, when managing diabetes, education is your best prescription! Take the time to learn about the disease and how to properly manage it in order to stay well!