Specialty Pharmacy: How Providers Manage Generic Specialty Drugs

When a patient gets a generic version of a specialty drug, many assume it’s just like picking up a regular pill at the corner pharmacy. But that’s not how it works. Even when a drug is no longer branded, if it’s a specialty medication, it still goes through a specialty pharmacy. And that’s where providers - pharmacists, care coordinators, nurses - play a critical role. This isn’t about saving money. It’s about safety, support, and complexity.

What Makes a Drug ‘Specialty’?

Not all expensive drugs are specialty drugs. And not all specialty drugs are biologics. The definition is based on how the drug is used, not just its price. According to the American Society of Health-System Pharmacists (ASHP), specialty drugs typically require special handling, storage, or administration. Many need refrigeration. Some must be injected or infused. Others come with strict safety rules called REMS (Risk Evaluation and Mitigation Strategies) from the FDA. These rules might require lab tests before each dose, or mandatory patient education.

Even when a generic version becomes available, these requirements don’t disappear. Take methotrexate, for example. It’s been generic for years. But when it’s used for rheumatoid arthritis or psoriasis at high doses, it’s treated as a specialty drug. Why? Because it’s toxic if not monitored. The same goes for oral chemotherapy agents like ibrutinib or tofacitinib. Their generics are chemically identical to the brand, but the delivery system doesn’t change.

Why Can’t Retail Pharmacies Dispense Them?

You might wonder: if it’s generic, why not just fill it at Walgreens? The answer lies in manufacturer distribution agreements. Many drugmakers - even for generics - require their products to be dispensed only through specialty pharmacies. This isn’t about profit. It’s about control. They want to ensure patients get the right counseling, proper storage, and follow-up care. Retail pharmacies often lack the infrastructure to handle temperature-sensitive shipping, REMS documentation, or disease-specific clinical support.

A 2023 Surescripts report found that specialty prescriptions require 12 to 15 patient data points to process - things like insurance status, prior authorization history, lab results, and administration training records. Retail pharmacies typically handle 5 to 7. That gap isn’t accidental. It’s built into the system.

The Workflow: More Than Just Filling a Prescription

Dispensing a generic specialty drug isn’t a simple transaction. It’s a multi-step process that takes an average of 7.2 days, according to a 2023 study in PMC. Here’s how it works:

1. Prescription intake - The pharmacy receives the script, often electronically, from a specialist’s office.
2. Prior authorization - The pharmacy contacts the insurer to prove medical necessity. This step alone can take 3 to 7 days, even for generics.
3. Financial assistance - Many patients can’t afford copays, even on generics. Specialty pharmacies help apply for manufacturer co-pay cards or patient assistance programs.
4. Clinical review - A pharmacist checks for drug interactions, dosing appropriateness, and patient history. For example, a patient on a generic version of a hepatitis C drug might need liver function tests before starting.
5. Patient education - Pharmacists or nurses call the patient to explain how to take the drug, what side effects to watch for, and how to store it. For injectables, they may even send a nurse to the home.
6. Specialty packaging and shipping - Medications are packed in temperature-controlled boxes with ice packs and shipped overnight. Tracking is mandatory.
7. Follow-up - The pharmacy calls again in 7 to 14 days to check on tolerance, side effects, and adherence.

This entire process stays the same whether the drug is brand or generic. The only difference? The price tag.

Providers Are the Real Value

The dispensing fee for a specialty prescription ranges from $250 to $500. Critics say that’s too high. But look at what’s included. In a 2022 Pharmacy Times interview, Cheryl Allen, a pharmacist and MBA, put it plainly: “It’s way more than ‘ding-dong, here’s your pills.’ There are patient care coordinators, nurses, and pharmacists working with these patients.”

Specialty pharmacy teams often specialize in one disease area - cancer, multiple sclerosis, rheumatoid arthritis. They build relationships. They remember that Mrs. Rivera’s daughter helps her with injections. They know Mr. Patel’s insurance denied his last refill because of a coding error. When he switches from the brand to the generic version of his drug, they don’t retrain him. They just update the label.

A MyHealthTeams survey from January 2024 found that 68% of patients preferred staying with the same specialty pharmacy when switching to a generic. Why? Because they trusted the team. They didn’t want to start over.

Biosimilars Are Changing the Game

True generics - chemically identical copies - only exist for small-molecule drugs. For biologics, which make up the bulk of specialty spending, we have biosimilars. These aren’t exact copies. They’re highly similar versions, approved after rigorous testing. And they’re growing fast.

In 2023, 98% of biologic medications were distributed through specialty pharmacies. That includes biosimilars like adalimumab-atto (Humira biosimilar) or bevacizumab-awwb (Avastin biosimilar). The FDA approved more than 40 biosimilars by 2025, and CMS rules now require Medicare Part D plans to cover them. That means more patients will get these drugs through specialty pharmacies - even though they’re cheaper.

The industry is preparing. ASHP reported in May 2024 that specialty pharmacies are upgrading their software to handle a 40% increase in biosimilar volume by 2026. The goal? Same level of care, lower cost.

Patient Experience: Mixed, But Often Positive

Patients have opinions. On Reddit, one user wrote: “My generic version of Xeljanz still comes through the same specialty pharmacy with the same nurse follow-ups, which I actually appreciate because she knows my case history.” Another said: “Went from $15 copay at Walgreens to $75 through specialty pharmacy with two-week delays.”

Trustpilot data from May 2024 shows specialty pharmacies average 3.8 out of 5 stars. Higher scores come from clinical support (4.2/5). Lower scores come from delivery speed (3.1/5). The frustration isn’t about the drug being generic. It’s about delays, confusion over copays, and lack of communication.

The fix? Real-Time Prescription Benefit (RTPB) technology. Surescripts found that using RTPB cut prior authorization time by 3.2 days on average. That’s huge. It means patients get their meds faster, even when they’re generic.

The Bigger Picture: Consolidation and Competition

The specialty pharmacy market is dominated by three players: OptumRx (32%), CVS Specialty (28%), and Express Scripts (24%). But hospitals are pushing back. A 2024 ASHP survey found 63% of health systems plan to build their own specialty pharmacies. Why? To control costs and keep patient data in-house.

This could disrupt the current model. If a hospital pharmacy starts dispensing generic specialty drugs directly to patients, will they still need the big players? Maybe not. But they’ll still need the same level of clinical support. That’s the real value - not the brand name, not the price, but the care.

What’s Next?

By 2028, specialty drugs are projected to make up 61% of global pharmaceutical sales. Biosimilars will be a big part of that. And as more generics enter the market, the pressure will grow to make specialty pharmacy services more efficient - without losing the human touch.

The message for providers is clear: your role isn’t changing. It’s expanding. Whether the drug is brand or generic, your job is to ensure it’s used safely, correctly, and with support. That’s what makes specialty pharmacy different. And that’s what keeps patients alive.