Understanding Your Specialty Pharmacy

What is a specialty pharmacy (SRx)?

• An SRx is a specialized pharmacy that manages the distribution of certain high cost or complicated medications to patients while offering comprehensive support, education, and referral services to improve access and adherence to these prescription medications.
• Most commercial prescription insurance plans contract with one or more preferred SRxs that their insured must use.
• Some SRxs specialize in only one medical condition, such as oncology, hepatitis, or infertility.

What is a specialty medication and why do I need to use an SRx to receive certain medications?

• Specialty medications have a high cost (for example:>$500 per dose or $6000 per year) and are used to manage complex conditions, like cancer, multiple sclerosis, growth deficiencies, and hepatitis. Many small pharmacies cannot afford to keep such medications on the shelf.
• In addition to cost, medication may be distributed by an SRx because it requires special handling, shipping, or storage.
• If the Food and Drug Administration (FDA) has determined that the medication poses certain risks that require the pharmacist to have specialized training, the patient to receive special education or specific processes for dispensing an SRx is used.
• In addition, there would be a significant financial loss if the medication was wasted, not used appropriately or stored improperly, due to the high cost of these medications.

Do I have to use an SRx and if so, how do I use one?

• If the pharmaceutical company that makes the medication requires the use of an SRx for dispensing of the medication, you MUST use an SRx.
• If your insurance company contracts with a specific SRx company, you MUST use this company for delivery of your medication.
• Your healthcare provider will call the SRx and give them the prescription information. The SRx will contact you to arrange delivery and provide any educational information.
• There may be an alternative in larger, academic medical systems with high tech pharmacy delivery services. These pharmacies MAY be able to obtain an override and dispense the medication directly to the patient with insurance company approval.
• Use the SRx's online portal to manage refills, delivery, and billing.
• If you are concerned about delivery safety, some SRxs will ship directly to your work, doctor's office, or even an affiliated local drug store.

What is the advantage of using an SRx?

• SRxs advertise an organized, patient-centered system for accessing these medications and helping you manage a complex medical condition.
• Many offer 24-hour per day pharmacist support, as well as medication and disease-specific counseling.
• SRxs encourage medication safety and cost containment for high-cost oral cancer drugs by closely managing the dispensing of these medications.
• The goal of insurers, SRxs, and healthcare providers is to increase adherence to oral cancer medications, increase patient engagement in the management of their illness and ultimately, improve patient outcomes.