Specialty drugs are medications used to treat complex illnesses such as cancer or multiple sclerosis.
Because these drugs often need careful monitoring when administered or special handling, they are often more expensive.
Coverage of specialty drugs often depends on the circumstances around administering the drug. For example, if the drug is given to a patient at a doctor’s office, it is more likely to be covered through medical benefits, whereas if it is administered via pill or injection at home, it’s more likely to be covered by the prescription drug benefits. There are often separate tiers for specialty drugs within prescription drug plans in which the individual is either required to pay a percentage of the drug or—in rare cases—a copay.
Due to the cost of specialty drugs—which is often $1,000 or more a month—if there is a copay, it can be several hundred dollars.
However, there are other avenues of assistance when faced with needing a specialty drug. Oftentimes manufacturers will provide programs to help assist individuals afford the drugs. Contact your Human Resources department or benefits provider learn more about what specialty drug coverage is available to you.
Content by Lockton Dunning Benefits with info from https://www.healthinsurance.org/glossary/specialty-drug/