Check out Psoriasis: An Inside Out Disease for more information on this topic. 

If you have psoriasis, an autoimmune disease that causes an overgrowth of skin cells, you may have tried various treatments to manage the scaly, itchy buildup of flaky skin called plaques. But when topicals haven’t made a dent, phototherapy hasn’t brought relief, and commonly prescribed immunosuppressants like methotrexate and cyclosporine are letting you down, your dermatologist might recommend getting a little more aggressive with your treatment. Same goes for psoriatic arthritis, an inflammatory joint-damaging disease that affects between 20 percent and 30 percent of people with psoriasis. If you don’t respond to first-line therapies like NSAIDs, steroids, or methotrexate, then what? 

“When you get beyond 10 percent to 30 percent body surface area involved, you certainly begin to think about the newer oral anti-inflammatory agents or biologics,” says Frank Wang, MD, Professor of Clinical Dermatology at University of Michigan Medical School.

As for patients with psoriatic arthritis, Samardeep Gupta, MBBS, Clinical Associate Professor of Rheumatology at University of Michigan Medical School, says he considers more aggressive options such as oral anti-inflammatories or biologics when a patient cannot tolerate or does not respond to methotrexate after 12 weeks.   

And while you will likely be relieved to know you have other options, you might be surprised to hear you won’t be able to pick up your new prescription at your neighborhood pharmacy. Instead, your doctor may explain that your medication is only available at something called a specialty pharmacy, which is usually a mail-order establishment.

That’s because medicines like biologics and the new-generation oral anti-inflammatories, such as PDE4 and JAK inhibitors, “typically require additional monitoring and extra patient education,” explains Renee Baiano, Clinical Program Manager at Walgreens Specialty Pharmacy. In short, they require a level of care your retail pharmacy has neither the time nor the resources to handle. 

What Is a Specialty Pharmacy?

You won’t find garden-variety antibiotics, statins, or blood pressure pills at a specialty pharmacy. As the name implies, these pharmacies focus on stocking and dispensing medications that have been FDA approved to treat rare, complex, or chronic diseases requiring lifelong management. What’s more, the treatments themselves are scientifically advanced, going beyond relieving symptoms like skin redness and joint soreness to targeting the underlying cause of the disease itself.  

Specialty drugs are frequently referred to as “high-cost, high touch” — high cost because they are among the most expensive out there, often costing $700 or more per month; high touch because, as Baiano suggests, it’s not as easy as plucking a bottle from your medicine cabinet and taking two a day. Often, they have specific dosing instructions; they might need to be given by injection or infusion or possibly at the doctor’s office.  

What’s more, “specialty medications often require special storage, such as refrigeration or even freezing,” says Baiano. “And in some cases, the patient will need certain supplies, which the specialty pharmacy can send out.”  

Got a Psoriasis Prescription. What Next?

With a regular prescription, you know the drill: Your health care provider calls it in to your local pharmacy and you show up a few hours later to pick it up. Not so with a specialty drug prescription. Instead, your health care provider will send the prescription to your specialty pharmacy, which is usually assigned to you by your insurance company.  

Next, the specialty pharmacy will want to make sure your insurance company will cover the drug — a process called prior authorization (PA). Because specialty drugs are so expensive, your insurance company will want proof that you’re truly a candidate for the medication your doctor has prescribed. Generally, the specialty pharmacy will work directly with your health care provider to gather the necessary information — things like test results, blood work, and a record of all the medications you’ve already tried that haven’t worked — and send it to the insurance company. Depending on your insurance company, the process can take anywhere from 1.5 to 17 days. 

If your specialty prescription has been approved, you’ll be responsible for your copay and the prescription will be filled and sent to your home, your doctor’s office, or in some cases a local pharmacy for pick up. 

What Else Your Specialty Pharmacy Can Do for You

A specialty pharmacy’s job doesn’t end when it delivers the psoriasis medication to you. In a way, that’s just the beginning.

If you’ve been prescribed a specialty drug, you’ll need to learn how to take it and store it properly — all training that will be provided by specialty pharmacy staff, who can also help if you need copay assistance. You’ll also be counseled by your specialty pharmacist on side effects and what to do if you experience them. And because these psoriasis drugs are so costly and complex, your specialty pharmacist will become a part of your life. 

“Your pharmacist will be checking in with you regularly to ask you certain questions to make sure you are doing well on therapy,” says Baiano, including:  

  • Are you having any side effects, so that you can discuss what to do about those 
  • How you’re doing with taking your medication as prescribed, so that they could help guide you through ways to make sure you’re taking your medication properly
  • How are you doing in general, so they can make sure your medication is working effectively for you 

“The specialty pharmacist’s goal is really to work with the entire care team, including dermatologists, the patient’s primary doctors, and other specialists to make sure the patient has the best outcome,” says Baiano. “On our end, it’s done through helping the patient manage any adverse reactions, overcome any barriers they have to not taking their medication properly, and filling any educational gaps.” Read on to learn 6 Surprising Things Your Pharmacist Can Do for You.”

And since most specialty pharmacies offer 24/7 phone access, you should feel confident that you have a solid support system at every point of your treatment journey. “Specialty pharmacies are focused on supporting patients throughout their journey — from the time of diagnosis to changes in therapy to ongoing care after treatment,” says Tricia Bardzak, a Walgreens Registered Manager for a specialty pharmacy in the Boston area. “We work with patients to ensure they’re able to quickly start important therapies and help them achieve their psoriasis treatment goals.”

Powerful Podcasts to Help You Live Better with Psoriasis

The Global Health Living Foundation/CreakyJoints is embracing audio storytelling as part of our mission to reach the chronic disease patient community where they are. Click here to listen to one of our many podcasts, including Getting Clear on Psoriasis, The Psoriatic Arthritis Club, Breaking Down Biosimilars, The Health Advocates, Talking Head Pain, MatterofVax, Gut Culture, and more.

This article is part of Psoriasis: An Inside Out Disease was made possible with support from Amgen.

Gombos, M. Understanding Specialty Pharmacy. Drug Topics. April 16, 2021. 

Inserro A. Authorization for Specialty Drugs Still a Patient Hurdle, Report Says. June 27, 2020. 

Interview with Renee Baiano, Clinical Program Manager at Walgreens Specialty Pharmacy.

Interview with Tricia Bartek, a Walgreens Registered Manager for a specialty pharmacy in the Boston area.

Interview with Samardeep Gupta, MBBS, Clinical Associate Professor of Rheumatology at University of Michigan Medical School. 

Interview with Frank Wang, MD, Professor of Clinical Dermatology at University of Michigan Medical School.

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