Specialty Medications

There’s something that’s really taking off in pharmaceuticals, but maybe not so much for the independent pharmacist. Specialty medications. Specialty medications are a newer designation of pharmaceuticals. They’re classified as high-cost and high complexity. Specialty medications are often drugs that are derived from living cells, and are injectable, infused or oral in delivery.

Specialty medications are often used to treat rare or complex conditions such as:

  • Rheumatoid Arthritis
  • HIV medications
  • Hepatitis C treatments
  • Psoriasis
  • IBS (inflammatory bowel disease)
  • Hemophilia
  • Cancer

Why So Special?

Specialty medications are often deemed so for a number of reasons:

  1. They’re very expensive. Medicare defines any drug with a negotiated price of $670 per month or more as a specialty medication. As a result, specialty medications typically require a higher cost share from the patient.
  2. Many of them have special handling requirements.
  3. Some are only available through limited distribution networks.

Specialty medications are also high in cost because the population they’re used for is relatively small. Pharmaceutical companies have invested a lot of money in creating specialty medications, but they’re not used by the general population.

How Do Specialty Drugs Affect the Independent Pharmacy?

The point is, some specialty medications may not be available at all independents pharmacies. They are high-cost items. John deems anything over $800 as high cost, although he admits this amount may vary based on the independent. When it comes to specialty medications, insurance companies typically want to drive the patient to their mail order or specialty house. Which John notes, mail order can be an issue with many specialty medications due to their sensitivity to heat. You don’t want them sitting in a hot delivery truck or on your front porch baking in the sun.”
Independents can try to get specialty medications, but they might not be able to cover the cost of these medications. There are success stories though, so it’s worth a try. More and more of these drugs are becoming available. And there’s a niche market opportunity here that can’t be ignored. John and Jerry owned a specialty pharmacy together a few years ago. The two agree that it can be a rewarding venture. Specialty drugs are an expanding market that is only going to get bigger. It’s a different set of parameters, but it’s definitely worth looking into.