What to Know About Specialty Pharmacies
If you’ve been prescribed medication that is unusual, expensive, or requires special handling, you may need to work with a specialty pharmacy. That may sound like a hassle, but many people find that specialty pharmacies are more convenient and helpful than the typical pharmacy. Here’s what you should know about working with a specialty pharmacy during your cancer journey.
What is a specialty pharmacy?
Specialty pharmacies provide medications that are used to treat rare or complex health problems. That includes high-cost oral drugs, self-administered medications, and drugs that require special handling, storage, or monitoring. Among people living with cancer, specialty pharmacies are used for chemotherapy medications, immunotherapy drugs, targeted therapy drugs, and others.
Generally speaking, specialty pharmacies provide drugs that are not found in your community or retail pharmacy. For instance, the FDA requires that some medications are prescribed and dispensed only by certified doctors and pharmacists. Specialty pharmacies typically provide these drugs, along with required education and monitoring.
Many specialty pharmacies do not maintain brick-and-mortar retail locations. Instead, you interact with them online, through an app, or via a telephone call. You’ll typically receive your medication via mail, or a technician will bring it to you directly. Some large pharmacy chains (like CVS) also have specialty pharmacy services and may offer in-person medication pickup at their retail locations.
Specialty pharmacies bring a highly personalized approach to patient care. Their staff is made of dedicated, trained professionals (such as licensed pharmacists and nursing personnel) who understand the challenges and obstacles you’re facing. Most specialty pharmacies are available during extended hours, seven days a week, to make sure your needs are met rapidly and seamlessly.
What is it like to use a specialty pharmacy?
Specialty pharmacies tend to provide a more attentive, high-touch service than normal pharmacies. When you get started, they will establish the relationship with a telephone call. Their goal is to ensure that you receive your medication, learn how to administer it properly, and carefully follow your doctor’s recommendations.
If you’re prescribed a medication that requires an injection or infusion, a pharmacy technician will come to your home to assist you. The same is true for medications that require special mixing or other preparation, as well as medications that need to be kept in special storage before use. Your specialty pharmacy technician may also show you how to handle and administer the medication yourself, so you can be more independent and take charge of your own healthcare experience. They’ll also teach you how to properly and safely dispose of any waste related to your medication.
As your treatment plan moves forward, a pharmacist or nurse with your specialty pharmacy will periodically check in with you. They’ll learn how your therapy is progressing and answer any new questions you might have. When it’s time to refill your medication, the pharmacy will remind you to ensure you don’t forget. At every step, your specialty pharmacy will work closely with you to keep you on track and optimize your health outcomes.
How will a specialty pharmacy impact my larger healthcare experience?
Generally speaking, specialty pharmacies play a more integrated role in your healthcare than other pharmacies. They can work directly with your doctor to adjust your medication dose and schedule, helping you achieve the very best results. They’ll also work closely with you to minimize side effects and possible interactions and/or complications from the medication. For many people, this kind of high-touch care and patient-centered support is a surprising and positive new part of the healthcare experience.
A specialty pharmacy may also work directly with your insurer to facilitate coverage. For instance, some medications require “prior authorization.” This means a pharmacy cannot dispense the drug to you without first obtaining your insurer’s permission and confirmation that the medication will be paid for. Specialty pharmacies are very familiar with prior authorization guidelines, and can streamline and facilitate the approval process.
How can I get the most out of my specialty pharmacy?
The best way to build a strong, trusting relationship with your specialty pharmacy is to communicate openly. Make sure they know about other medications you’re taking as well as any side effects or complications you’re experiencing. Remember, your pharmacy is here to help you. The more information they have, the more helpful they can be.
It’s also important to loop in your specialty pharmacy if you’re anticipating any lifestyle changes that might impact your medication use. For instance, if your mailing address is changing or if you’re planning to travel, let your pharmacy know. They’ll work with you to ensure your medication supply isn’t interrupted.
Finally, don’t be shy about reaching out to your specialty pharmacy for both emotional and financial support. Many specialty pharmacies offer counseling services to help you deal with the stress of your treatment journey. They may also have reimbursement specialists on hand. These financial experts can help protect your wallet by getting the maximum possible coverage from your insurance plan.
How are specialty medications paid for?
When a specialty pharmacy receives a prescription from your doctor, it will file an insurance claim on your behalf to get the medication cost covered. If your insurance company requires prior authorization, the specialty pharmacy will help facilitate this process and submit the appropriate paperwork. If a claim is denied, your specialty pharmacy can work on your behalf to appeal the decision. Be sure to notify your care coordinator if your health insurance benefits should change in any way.
Unfortunately, specialty medications can be pricey. It’s not unusual for costs to run into the tens or even hundreds of thousands of dollars. If your insurance plan doesn’t fully cover these costs, your specialty pharmacy care coordinator can refer you to a financial assistant who can recommend alternative financial support options. That may include the Patient Advocate Foundation, a state assistance program, or a manufacturer’s Patient Assistance Program (PAP). Contact your medication’s manufacturer to learn more about Patient Assistance Programs.
Be sure to ask your healthcare team for other sources of financial assistance with high-cost medications that you are unable to afford. These services can seriously lower out-of-pocket expenses, helping people access medications they could not otherwise afford.
Specialty pharmacies fill a very important niche in our healthcare landscape. They offer medications you cannot obtain elsewhere, while providing the guidance and education you need to take them safely. Most importantly, your specialty pharmacy will be a supportive and attentive partner through every step of your cancer journey.
The content on this website is intended to provide the best possible information for you, but should not be considered—or used as a substitute for—medical advice. If you have questions about your diagnosis or treatment, please contact your health care provider(s). For questions or comments about this content, please email us at [email protected].