Understanding Your Specialty Pharmacy

What is a specialty pharmacy (SRx)?

• A specialty pharmacy (SRx) is a pharmacy that helps patients with high-cost or complicated medications. They offer support, education, and referrals to improve access to these medications and to help patients take them as prescribed.
• Most commercial prescription insurance plans work with one or more SRx. You will have to work with the SRx that your insurance plan has a contract with if you need a special medicine.
• Some SRxs work with only one medical condition, like oncology (cancer), hepatitis, or infertility.

What is a specialty medication and why do I need to use an SRx to get it?

• Specialty medications have a high cost (like $500 per dose or $6000 per year) and are used for complex conditions, like cancer, multiple sclerosis (MS), growth problems, and hepatitis. Money would be lost if the medication was wasted, not used correctly, or stored in the wrong way. Many small pharmacies cannot afford to keep high-cost medications on the shelf.
• You may need to get a medication through an SRx because it has special handling, shipping, or storage needs.
• An SRx is used if the Food and Drug Administration (FDA) says that the medication has certain risks that require the pharmacist to have specialized training, the patient needs special education, or if there are specific directions for dispensing the medication. 

What should I expect when using an SRx?

• For some medications, the pharmaceutical company that makes the medication will require you to use an SRx. 
• If your insurance company contracts with a specific SRx, you MUST use this SRx to get your medication.
• Your healthcare provider will call the SRx and give them your prescription information. The SRx will contact you about delivery and give you any education you might need about the medicine.
• You may be able to use the SRx's online portal to manage refills, delivery, and billing.
• If you are worried about delivery safety, some SRxs will ship directly to your work, doctor's office, or even a local drug store.
• If you are being treated in a large academic medical system, the hospital pharmacy MAY be able to obtain an override and dispense the medication directly to you with approval from your insurance company. Talk with your provider about this option.

What is the benefit of using an SRx?

• SRxs offer an organized, patient-centered approach for getting you your medications and helping you manage a complex medical condition.
• Many offer 24-hour pharmacist support.
• Some offer medication and disease-specific counseling.
• SRxs help with medication safety.
• SRx’s can help keep costs down for high-cost oral cancer drugs by closely managing how they are dispensed.