Specialty Drug
A high-cost medication — typically above $1,000 per month — that treats complex or chronic conditions and often requires special handling, storage, or administration.
How It Works
Specialty drugs represent less than 2% of all prescriptions but account for over 50% of total drug spending in the United States. They include biologics, cancer treatments, autoimmune therapies, and gene therapies. Specialty drugs often require refrigeration, injection or infusion, and close monitoring by a healthcare provider. Insurers typically place specialty drugs on the highest formulary tier with the greatest cost-sharing. Patient assistance programs and specialty pharmacies exist specifically to help patients access and afford these medications.
Related Terms
- Biologic Drug — A complex medication derived from living cells — including monoclonal antibodies, vaccines, and cell therapies — that treats serious conditions like cancer and autoimmune diseases.
- Formulary — A list of prescription drugs covered by an insurance plan, organized into tiers that determine how much the patient pays for each drug.
- Prior Authorization — A requirement by an insurer that a patient's doctor must get approval before the plan will cover a specific drug — used to control costs and ensure appropriate use.
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About This Definition
This definition is part of the DrugPrice Drug Pricing Glossary — 34 terms explaining how prescription drug pricing works in the United States. All definitions are written in plain language for patients, caregivers, journalists, and healthcare professionals.