Specialty drug benefits overview

Specialty drugs (or specialty pharmaceuticals) are the most expensive prescriptions you can buy — around $1,000 or more per month. Unfortunately, they are also the only option for many people who have complex, and otherwise untreatable, conditions.

What are specialty drugs?

Specialty drugs are expensive prescription medications that are used to treat chronic, complex conditions. Individuals suffering through cancer, multiple sclerosis or rheumatoid arthritis might be prescribed a specialty drug.

Special handling — like refrigeration and supervised injections — is often required for these medications, contributing to the high costs. Patients who need a specialty drug are usually monitored before and after it is administered to check for side effects and treatment progress.

Are specialty drugs covered?

Whether a specialty drug is covered depends on your benefits plan. A specialty drug could be covered under medical or prescription drug insurance. How the drug is administered often determines which benefit covers the medication. For instance, self-injections at home might place it under prescription drug insurance, whereas supervised injections in a clinic might place it under medical insurance.

What do I pay?

Specialty drug costs are steadily rising and projected to reach around $400 billion by 2020, according to UnitedHealth Group. In 2016, the United States spent about $121 billion on specialty drugs. Similarly, specialty drug spending is predicted to surpass traditional pharmacy spending by 2018, according to the National Business Group on Health (NBGH).

Specialty drug costs are steadily rising and projected to reach around $400 billion by 2020.

Due to the high costs of these prescriptions, many benefit plans include a separate tier for specialty drugs. The tier specifies how much an individual must pay for the specialty medication. For instance, the specialty drug tier would differ from what you pay for normal prescriptions. Your plan will determine if you pay a flat copay or a percentage of the specialty drug costs.

Where can I find help?

Your doctor is the first person you should speak with regarding lower specialty drug costs. It is possible there are more affordable alternatives to your prescription, or there is an option that would treat multiple conditions.

If you have any questions about your specialty prescriptions being covered under your benefits plan, please speak with HR to review your options.