What Are Specialty Pharmacies And Why Do We Use Them?

Let me start by saying that I realize I am lucky to have medical insurance provided through my husband’s employer. There are many people in the lung cancer community who are not that fortunate. However, my husband changed jobs recently which led to a change in insurance companies. This should have been seamless since my oncologist and my medical center continued to be covered by the new insurance company. However, the week-long stressful process I experienced trying to renew my targeted therapy prescription was anything but easy!

Waiting for the mail

You see, I receive my targeted therapy medication — a pill called Tagrisso taken daily by mouth — through a specialty pharmacy who is approved to dispense this medication. I can’t go to the local CVS or Walgreens to re-order my prescription; instead, I have to call a pharmacy in another state and they send me my life-saving medicine every month via Fed-Ex.

In a normal month, this is a somewhat stressful process. I am not allowed to reorder my prescription until I am down to 10 remaining pills and since specialty pharmacies are closed over the weekend and holidays, this has resulted in sometimes cutting the receipt of my order a little too close for comfort. This is especially an issue if I have days that I will be out of town in a given month. Because my medication costs several thousands of dollars, I need to arrange my schedule to be home when my Fed-Ex package arrives. I don’t want my very expensive and necessary drugs left on my doorstep and chance theft or exposure to the elements.

Frustrations of changing insurance

Changing insurance companies this month added a whole new level of difficulty to this monthly specialty pharmacy process. Even though I didn’t need to switch pharmacies as a result of my insurance change, I was told to have a new Tagrisso prescription faxed over to the insurance company by my oncologist’s office, wait for that new prescription to be authorized by the insurance company and then submitted to the specialty pharmacy, where it was necessary to process it as if I was a completely new customer. No one could tell me why all this time-consuming work needed to be done as opposed to just changing my insurance information with the specialty pharmacy. I spent many hours on the phone, staying on hold and getting stressed out that it all wouldn’t be completed before I ran out of pills!

Doing some digging on specialty pharmacies

While I was waiting, I did a little research about why specialty pharmacies are in business. According to an April 2018 article in U.S. Pharmacist, about 30% of all current prescriptions are distributed through specialty pharmacies¹. This is an extremely fast-growing business area in healthcare as drugs are designated as “specialty” mainly based on their high cost. In order to receive their accreditation, specialty pharmacies are required to have more highly skilled and knowledgeable personnel to deal with patients with complex medical issues.

I’m not sure if this specialized focus is part of the reason why it was so complicated to change my insurance information or not. Regardless, I learned a little more about why specialty pharmacies exist and fortunately, my prescription ended up arriving in time after all!

Editor’s Note: We are extremely saddened to say that on June 23, 2024, Ivy Elkins passed away. Ivy’s advocacy efforts and writing continue to reach many. She will be deeply missed.