What are specialty drugs?
A specialty drug is a type of prescription drug that, in general, requires special handling or ongoing monitoring and assessment by your doctor, or may only be available at certain pharmacies. Generally, specialty drugs are the most expensive drugs on a formulary.
What are they for and how do I take them?
Specialty drugs treat many diseases such as cancer, multiple sclerosis, hepatitis C, rheumatoid arthritis. They may be injected, infused, inhaled, or taken by mouth. Be sure you understand how and when to take the medication.
How do I know if my medication is a specialty drug?
Drug lists can't tell you the price of a prescription. But you can see if a prescription is considered a specialty drug, and whether it needs prior authorization or step therapy before your plan will help pay for it.
Click here for your plan's Drug Formulary.
How can I get my specialty drug prescription filled?
Specialty drugs are only available in a one-month supply. There are two ways to fill specialty drug prescriptions:
- You can fill prescriptions for specialty drugs at a retail pharmacy, but not all pharmacies will dispense specialty drugs. Call your pharmacy in advance to verify that it can fill your prescription.
- You can have your specialty drugs processed through our pharmacy benefit managers’ specialty pharmacies.
- Commercial members ask their doctor to fill out and send a form to Magellan Rx Pharmacy. Click here for the enrollment form.
- Medicare Advantage members call 1-800-237-2767 to reach CVS Specialty.
Some manufacturers limit the distribution of specialty drugs. These drugs are only available through designated pharmacies. Please talk to your doctor about whether this applies to your medication and if so, how to fill prescriptions for exclusive limited distribution drugs.
What are biosimilars?
Biosimilars are FDA-approved drugs that are highly similar to brand-name drugs.
Are biosimilars the same as generic drugs?
No. Generics have identical active ingredients to brand-name drugs and are made from synthesized chemicals.
A biosimilar is a biologic medical product highly similar to another already approved biological medicine. Biosimilars are approved according to the same standards of pharmaceutical quality, safety and efficacy that apply to all biological medicines.
Is it safe to switch to a biosimilar?
Biosimilars are FDA approved. They are as safe and effective as their brand-name counterparts.
Will switching to a biosimilar change my treatments or my drug's effectiveness?
No. The process and experience will be the same. You should expect the same effectiveness as you do from the drug you are taking currently.
Why am I being asked to switch to a biosimilar if my current therapy is working?
The biosimilar is a safe and cost-effective option to treat your condition. This allows the health plan to cover these high-cost products while keeping the cost of health care affordable.
Where can I learn more?
Talk to your doctor if you have questions about your biosimilar treatment.
Still have questions?