Specialty drugs are high-cost prescription medications used to treat complex, chronic conditions like cancer, rheumatoid arthritis, and multiple sclerosis.
Specialty drugs sometimes require special handling and administration (typically injection or infusion), and patients using a specialty drug may need careful oversight from a health care provider who can watch for side effects and ensure that the medication is working as intended.
Specialty drugs might be covered through either medical or prescription drug insurance. How a specialty drug is covered usually depends on where the patient receives the drug. If the patient takes a pill or self-injects the drug at home, it is more likely to be covered through his or her prescription drug benefit. If the patient receives the drug at a doctor’s office or an outpatient clinic, it’s more likely to be covered through the medical benefits portion of his or her health insurance coverage.
High-cost medications are typically priced at more than $1,000 per 30-day supply; including self-administered injectables, professionally administered injectables/ infusions, and oral medications
- Biotechnology products
- Orphan or Ultra-Orphan drugs
- Medications that are included in a specialty therapeutic drug class strategy
