Whether living with a chronic condition, like rheumatoid arthritis, or undergoing treatments for a serious illness, specialty medication may be an important part of your therapy regimen. These specialized drugs can be life transforming, life sustaining and sometimes life-saving. Understanding what they are can help you make informed decisions about the future of your health care.
The Evolution of Specialty Drugs
Niche new medicine began in the 1980s to treat organ transplants and cancer, giving way to a rise in specialty medications. As medical advancements have grown, so has the demand for personalized treatments and specialized therapies. An estimated 7,000 specialty prescriptions drugs are currently in development.[1,2] This era of clinical support and medication therapy has brought about significant advancements in treatment for many diseases, and has the potential to continue doing so.
What is Considered a Specialty Medication?
Specialty drugs are generally used to help treat a number of rare, serious and complicated conditions, such as hepatitis C, multiple sclerosis and cancer.[3] The rise of chronic disease cases has also led to a breakthrough of specialty medication therapies as well. Oftentimes these drugs are by injection or infusion, but they can also be administered in other ways. While there is no exact definition of specialized medications, certain factors help classify these drugs:
- The drug is used to treat rare medical conditions or complex chronic medical conditions.
- The drug requires temperature control or other special handling and shipping requirements (i.e., refrigerated, or frozen shipping).
- The drug has dispensing standards and can only be filled at a pharmacy designed to handle these specialty medications.
- The drug requires in-depth member education and personalized monitoring to reduce complications and ensure that the medication is working as intended.
- The drug may have limited availability and can come at a high cost.
What Makes Specialty Drugs So Special
These drugs can offer new, effective ways to treat conditions that historically had few treatment options. While these medications provide a new level of hope for the people who require them, they are complex and require special handling. Additionally, missing a dose could cause major problems for those with serious medical conditions. Because of this, many specialty pharmacies, like Elixir Specialty*, are designed to work with patients to help them manage the medication regime and side effects.
Traditional Pharmacy vs. Specialty Pharmacy
The key distinction between a traditional retail pharmacy and a specialty pharmacy are the conditions they treat and the medications they dispense.
- Traditional retail pharmacies dispense medications to treat general health conditions like allergies, seasonal flu or a short-term common infection. Many of these medications are easy to understand and can be managed with little instruction.
- Specialty pharmacies dispense unique, condition-specific medications that require close monitoring and patient management. Pharmacists are certified for specialty medication management, and are often certified in a disease-specific category. The type of service goes above and beyond the typical retail assistance and may include:
- Greater access to customer service and licensed pharmacists
- Mail order services or sending Rx to the doctor’s office if requested
- Customized and individual care plans
- Training for self-administering medications, including supplies
- Adherence management and patient education
- Quality control and outcome management reporting
- Coordination with a registered nurse who is trained for specialty medications
Specialty medications are here to stay as they can unlock new treatment options and provide better health outcomes to those who need it most. If you are prescribed a specialty medication, choose a specialty pharmacy that has the personal attention you need to ensure you manage your medication therapy best.
[1] The Emergence of Specialty Pharmacy (2020). Journal of Managed Care and Specialty Pharmacy. https://www.jmcp.org/doi/full/10.18553/jmcp.2020.26.3.229a
[2] Top Tech Predictions for the Future of Specialty Pharmacy (2021). BioPharmaDive. https://www.biopharmadive.com/press-release/20210721-top-tech-predictions-for-the-future-of-speciality-pharmacy/
[3] Individualized Care for Members With Complex Conditions. Elixir Solutions. https://www.elixirsolutions.com/plansponsors/pharmacy/specialty-pharmacy
S7694_22-7025_enewsletter 2022_C Reviewed 11/17/22
*Other pharmacies are available in our network
Elixir Insurance is a Prescription Drug Plan with a Medicare contract. Enrollment in Elixir Insurance depends on contract renewal. For more information, please call our customer service number at 833-684-7267. TTY users call 711. We are available 24 hours a day, 7 days a week. ATTENTION: If you speak Spanish, language assistance services, free of charge, are available to you. Call 833-684-7267 (TTY: 711). ATENCIÓN: si habla Español, los servicios de asistencia lingüística, sin cargo, están disponibles para usted. Llamada 833-684-7267 (TTY: 711).
Elixir Insurance, 7835 Freedom Avenue NW, North Canton, OH 44720, United States
