Specialty Drugs
Overview:
Specialty drugs are medications that typically require special handling, administration, and monitoring or have complex dosing requirements. They are often used to treat chronic or rare conditions. These drugs may be injected, infused, or taken orally, and they often come with higher costs compared to traditional medications. Specialty pharmacies usually handle their distribution and management. On average, specialty medications can cost thousands of dollars per month or dose. The high cost is often attributed to the complex manufacturing process, limited patient population, research and development expenses, and the specialized nature of these medications.
Are they covered?
Coverage for specialty medications can vary depending on the specific plan and insurance provider. Many plans categorize specialty drugs as a tier of their formulary, determining the level of coverage and cost-sharing for the medication.
Before starting a specialty medication, you must review your insurance plan's preferred drug list or formulary to check coverage details. This can help you understand copayment, coinsurance, and prior authorization requirements associated with the medication.
What if I have questions?
Please contact your healthcare provider or pharmacist for questions about the medication's purpose, dosage, side effects, and administration.
If you have questions about your insurance coverage, please get in touch with your insurance provider directly.
The information provided is for educational purposes and should not be used during any medical emergency or for the diagnosis or treatment of any conditions. Consult with your medical provider for diagnosis and treatment of all medical conditions. Call 911 for medical emergencies.