What is considered a specialty drug?

Prescription drug coverage can help individuals pay for necessary medications to treat health conditions, such as high blood pressure, diabetes, and arthritis. Prescription drug coverage is often included in group health insurance plans or can be purchased alone or as a rider on an individual health insurance plan. If you have prescription drug coverage, your share of your prescription medication’s cost is often based on the medication itself.

Generic drugs tend to be the most affordable, followed by low-cost name brand drugs. Name-brand drugs with generic alternatives may not be covered, or you may be responsible for a higher coinsurance percentage or a higher copay. The most expensive type of drug is known as a specialty drug.

Specialty medications are developed through intensive biotech research and generally require special handling. They are most often likely to be prescribed for chronic, complex, or rare health conditions that require carefully monitored care, such as cancer, hepatitis C, hemophilia, rheumatoid arthritis, cystic fibrosis, infertility, HIV, or multiple sclerosis. These health conditions often have few or no other alternative treatments.

Treatment with specialty drugs may be administered at home, either on your own or by a home health care aide or nurse, or at the hospital, and it must often be monitored closely. They may be injected, inhaled, infused, or taken orally.

These medications may be covered by an individual health insurance at a rate of 67 to 75 percent, leaving you with a coinsurance rate of 25 to 33 percent. Specialty drugs can cost as little as $400 to more than $1,500 a month out of pocket, but following the health care regimen properly is essential to maximizing the benefits of the specialty drugs.

Contact one of our health insurance agents today to learn more about how you can get health coverage for prescription drugs or specialty drugs.

To learn more about health insurance plans, visit Wikipedia.org

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