Is a specialty pharmacy right for me?
Published: September 2, 2021
If you have Crohn’s disease or ulcerative colitis, then you know how hard it can be to pay for your medication. A Foundation study found that people with inflammatory bowel disease (IBD), especially Crohn’s, pay three times the total health care costs and double the out-of-pocket expenses than people without IBD. And people with severe cases may need long-term to permanent use of immunosuppressives and/or biologics to reach remission. These complex treatments often come with side effects. It’s easy to understand why people stop their treatment. But medication nonadherence causes 30–50% of treatment failures, so it’s important to stay on track.
Living with IBD requires extra support and care. One option is to work with a specialty pharmacy.
What do specialty pharmacies do?
Specialty pharmacies deliver services that can help you get your medication and stay on your treatment plan. These services go beyond what most retail pharmacies provide. Your neighborhood pharmacy is a great option for short-term bugs like an ear infection or the flu. But a specialty pharmacy helps people living with a chronic illness by providing:
- Education, support, and resources: In addition to the resources provided by the Crohn’s & Colitis Foundation, specialty pharmacies take a proactive approach to help people take their medication as prescribed.
- Injection training: Learning how to inject medication can be challenging. Reloading and priming a cartridge, drawing the right dose into a syringe, and preparing the injection site is important. Injection training is part of standard patient counseling at specialty pharmacies.
- Specialty care coordinators: Specialty care coordinators are dedicated staff that work at specialty pharmacies to make sure your treatment is consistent, and you have what you need to stay on your medications. Care coordinators may call you to see how you’re doing, ask if you’re experiencing any side effects, arrange medication shipments and explain easy refill options.
- Financial assistance and prior authorization: Specialty pharmacies can help you fill out and submit paperwork for financial assistance programs and complete the prior authorization process for you.
- Expertise: Specialty pharmacists have years of experience working with IBD. Look for a specialty pharmacy with consistent pharmacist availability, some offer 24/7 clinical support, others offer less.
What to look for in a specialty pharmacy
Some specialty pharmacies invite accrediting agencies to inspect and test their products and review policies and procedures. These agencies set standards to make sure people get safe and effective products, so be sure to check for accreditation status. You can learn more about pharmacy accreditation and standards by visiting Accreditation Commission for Health Care (ACHC).
Another important thing to look for is a specialty pharmacy with a large distribution network with access to limited-distribution drugs (LDDs). LDDs are medications that are considered complicated to manage, are expensive and require special handling, administration, or monitoring. Given the complexity of these drugs they may only be distributed through certain pharmacies. While some specialty medications are available at almost every specialty pharmacy, LDDs are available only at limited locations.
You should check with your insurance carrier to understand coverage related to your medications and which medications are considered specialty drugs. Your insurance plan may also provide information on specialty pharmacies and how to access.
Talking to your pharmacist
No matter where you get your medication, from a specialty pharmacy, retail chain or your neighborhood pharmacist, all pharmacists are great resources. Many local and retail pharmacies have consultation rooms or other private areas where you can chat with the pharmacist and ask questions. Before you meet with a pharmacist, it’s important to prepare. Take a few minutes to write questions on your phone or notepad so you remember all your questions. Share a complete list of medications you are taking, including any over-the-counter medications and supplements. Questions you may want to ask:
- Should my medications be taken at a specific time of day?
- Should my medication be taken with food, without food, or are there foods to avoid?
- Will the medication interfere with other treatments?
- Are there discount programs that can help me afford this medication?
Review your insurance policy when choosing a pharmacy or specialty pharmacy to understand what is covered and what isn’t. Your doctor can also help you choose the pharmacy that’s right for you and your treatment. If you have questions about your pharmacy options, our IBD Help Center is here to help you. You can contact them at [email protected], 888MYGUTPAIN, or by live chat on our website, Monday–Friday, 9 a.m.–5 p.m. ET.
Laura Wingate is Executive Vice President, Education, Support, & Advocacy for the Crohn's & Colitis Foundation.
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