What Is a Specialty Pharmacy?

Medically Reviewed by Thai Hensch, RPh, MBA, CPHQ, Director of Pharmacy Care Management

You usually have your prescriptions filled at a retail pharmacy down the street from your home, but your medical provider just prescribed a medication that can only be filled by a specialty pharmacy. What is a specialty pharmacy?

Put simply, a specialty pharmacy is a pharmacy that specializes in medications that treat highly complex medical conditions, such as cancer, rheumatoid arthritis, or multiple sclerosis. These medications often require special clinical management, handling, and storage that most retail pharmacies can’t provide.

That’s not the only benefit of a specialty pharmacy, though. Learn more about what specialty pharmacies are and how they can help you manage complicated medical needs.

Understanding Specialty Medications

To understand what a specialty pharmacy offers, it’s helpful to understand specialty medications. These drugs are more complex than everyday prescription medications, like blood pressure medications or antihistamines. Their complexity may be related to the ingredients, how they are taken, their side effects and how those are managed, or their cost or insurance coverage, according to the National Association of Specialty Pharmacy.

In addition, specialty medications are usually used to treat more complex medical conditions, including –

• Atopic dermatitis
• Bleeding disorders
• Cancer
• Crohn’s disease
• Cystic fibrosis
• Hepatitis
• Human growth hormone deficiencies
• Multiple sclerosis
• Rheumatoid arthritis

Immunosuppressants, medications that prevent the body from rejecting a transplanted organ, may also be considered specialty drugs.

How Specialty Pharmacies Operate

Specialty pharmacies are uniquely designed to serve people who have complex medical conditions that require specialty medications.

“These medications are used to treat complex conditions that often require ongoing monitoring and support,” said Thaiane Hensch, Director of Pharmacy Care Management at Essentia Health. “Specialty pharmacies are set up to meet these requirements, and your experience using a specialty pharmacy will likely look different than your experience at a retail pharmacy or local drugstore.”

Pharmacists and other pharmacy team members at specialty pharmacies go through specific training to help you get the most benefit out of your medication. They will make sure you know how to use or take your medication. They can provide medication therapy management, a service in which your pharmacist will review your treatment plan to see if a new medication will interact with others you take and offer other tips to help you follow your treatment plan. They’ll also monitor your progress and talk with your care team, if needed.

Plus, pharmacists and other specialty pharmacy team members can help you navigate costs and insurance coverage for specialty medications, which can be very complicated. Your pharmacy team can make sure they have prior authorizations and other necessary paperwork from your health care team.

If your insurer doesn’t cover a medication or you don’t have insurance, a specialty pharmacy team can help you find payment options, such as rebates or coverage assistance through the drug manufacturer. They can also check into generic and biosimilar options, if available, which may be less expensive than brand-name drugs.

Finally, your specialty pharmacist will follow up with you regularly to keep you on track with refills and help you identify and manage side effects.

How to Choose the Right Specialty Pharmacy

If your care team has prescribed a specialty medication, your insurance provider may require that medication be dispensed through a specialty pharmacy. In other cases, a drug manufacturer may limit its distribution to specialty pharmacies only.

When that’s the case, how do you choose the right specialty pharmacy?

The first thing to consider is your insurance coverage. Many insurance providers contract with specific specialty pharmacies, so you may be required to use a certain pharmacy or a pharmacy within a network of specialty pharmacies.If you have several options to choose from, consider some key factors.

First, look for a specialty pharmacy with expertise in your medical condition and medications. These pharmacies will know how to best care for your needs.

Next, consider logistical factors that can make your experience easier, such as – 

• How the pharmacy team communicates with patients
• How they manage prescription refills and billing
• Whether the pharmacy offers home delivery or mail order services
• Whether the pharmacy is part of a larger health care organization

The most significant factor to consider? Whether you’re comfortable with the pharmacist, support team, and the care they provide.

“When you’re living with a rare or complex medical condition, getting your medication shouldn’t be another burden,” Hensch said. “Our specialty pharmacy team has advanced training and expertise to provide that highly personalized care for patients facing these complicated health issues. Our patients consistently rate our services well above the national average, and that reflects our commitment to making sure they get the medications and support they need.”

The Bottom Line

If you have a rare or complex health condition, you may need a specialty pharmacy to fill your prescriptions. Specialty pharmacies are dedicated facilities with the skills, knowledge, and capabilities to deliver medications that require ongoing clinical management and special handling due to factors such as ingredients or cost.

Specialty pharmacists and other members of the pharmacy team offer more hands-on attention to help ensure you understand how to use and take your medication correctly. They can also help you navigate insurance and financial concerns. Ultimately, specialty pharmacies help you maximize the benefits of your treatment plan.

At Essentia Health, we offer a full range of pharmacy services to meet your medication needs, including Essentia Health Specialty Pharmacy for specialty medications. Call 715-817-7145 to learn more or to refill a specialty medication.