Specialty Pharmacy: How Providers Dispense Generic Specialty Drugs

When you hear the word specialty pharmacy, you might think of expensive brand-name drugs for rare diseases. But here’s the reality: more and more generic specialty drugs are flowing through these same channels - and providers play a critical role in making sure they get to patients safely and effectively.

What Exactly Is a Generic Specialty Drug?

Not all generics are created equal. A generic version of a common pill like metformin? That’s simple. But a generic version of a drug like adalimumab (Humira) or infliximab (Remicade)? That’s different. These are biologics - complex, protein-based medications made from living cells. You can’t just copy them like a tablet. Instead, you get biosimilars, which are highly similar versions approved by the FDA after rigorous testing. They’re not exact copies, but they work the same way and are proven safe. And yes, they count as generic specialty drugs in the eyes of insurers and providers.

These drugs aren’t sold at your local CVS. They’re distributed through specialty pharmacies because they require special handling - refrigeration, precise dosing, or infusion setups. Even when the drug is cheaper, the delivery system stays the same.

Why Can’t Retail Pharmacies Dispense Them?

You might wonder: if it’s a generic, why can’t I just pick it up at Walgreens like my blood pressure med? The answer lies in distribution rules. Many manufacturers - even for biosimilars - lock their drugs into specialty pharmacy networks. This isn’t about profit. It’s about control. These drugs come with REMS programs (Risk Evaluation and Mitigation Strategies) mandated by the FDA. That means patients need education, monitoring, lab tests, and follow-up calls. Retail pharmacies don’t have the staff, systems, or training to handle this.

A 2023 study found that specialty pharmacies require 12-15 data points per patient just to start treatment. Retail pharmacies? Five to seven. That gap isn’t accidental. It’s built into the system because the risk profile is higher.

The Provider’s Role: More Than Just Writing a Prescription

Providers - doctors, nurse practitioners, physician assistants - are the gatekeepers. They don’t just write the script. They decide which specialty pharmacy to use, and they often have to fight for it.

Many providers now work directly with specialty pharmacies to streamline the process. They’ll call the pharmacy before prescribing to confirm coverage, check prior authorization requirements, or ask if the patient has been on a similar drug before. Some clinics even have dedicated staff who handle prior auths and financial assistance applications so the provider can focus on care.

It’s not uncommon for a provider to say: “I’m prescribing the biosimilar version of adalimumab. Can you confirm your pharmacy can handle it? Does the patient have a care coordinator?”

This level of coordination matters. A patient switching from Humira to a biosimilar might have the same condition, but their body reacts differently. A provider who’s involved in the transition can spot early signs of reduced effectiveness or side effects.

How Specialty Pharmacies Handle Generic vs. Brand

The workflow is nearly identical whether the drug is brand or generic. Here’s what happens:

1. Prescription received - sent electronically from the provider’s EHR system.
2. Insurance verification - the pharmacy checks coverage, copay, and prior authorization. Even biosimilars often need pre-approval because insurers still treat them as specialty drugs.
3. Financial assistance - many patients can’t afford even the reduced cost of a biosimilar. Specialty pharmacies help apply for manufacturer coupons or patient assistance programs.
4. Clinical review - a specialty pharmacist reviews the patient’s history, current meds, lab results, and potential interactions.
5. Patient education - a nurse or care coordinator calls the patient to explain how to inject or infuse the drug, what side effects to watch for, and when to call for help.
6. Shipping - packaged with cold packs, delivered to the home. No pickup required.
7. Follow-up - calls at 7, 14, and 30 days to check on tolerance, adherence, and lab results.

This process takes 7-9 days on average. Retail prescriptions? 1.2 days. But the difference isn’t inefficiency - it’s necessity.

Real Patient Experiences: Frustration and Relief

Patients have mixed feelings. One user on Reddit shared: “My generic version of Xeljanz still comes through the same specialty pharmacy with the same nurse who’s known me for three years. I wouldn’t trade that for a faster pickup.”

Another wrote: “Went from a $15 copay at Walgreens for methotrexate to $75 through the specialty pharmacy. Took two weeks. No one explained why.”

The difference? In the first case, the provider and pharmacy kept the care team consistent. In the second, the patient was left in the dark. Studies show 68% of patients prefer staying with the same specialty pharmacy when switching to a biosimilar - not because of the drug, but because of the people.

Why This Model Isn’t Going Away

Some health systems are trying to bring specialty dispensing in-house. Over 60% of hospitals now plan to launch their own specialty pharmacy services by 2026. But that doesn’t mean the current model is broken. It means the complexity is growing.

Biosimilars are expected to make up 40% of all specialty drug volume by 2026. That’s a flood of new prescriptions - all needing the same level of oversight. Retail pharmacies simply can’t scale to meet that demand. Specialty pharmacies, despite their delays, have the infrastructure: temperature-controlled logistics, REMS-compliant software, disease-specific pharmacists, and care teams trained in autoimmune, oncology, and rare disease care.

And here’s the key insight: the cost of the drug doesn’t change the service needed. A $500 biosimilar still needs the same education, monitoring, and support as a $10,000 brand drug. The value isn’t in the pill. It’s in the care around it.

What’s Changing in 2025

New CMS rules now require Medicare Part D plans to cover all FDA-approved biosimilars without extra barriers. That’s a big win for patients. But it also means more prescriptions will hit specialty pharmacies - and providers will need to be even more proactive.

Technology is helping. Real-Time Prescription Benefit tools now cut prior authorization time by over three days. That’s huge. But the human element still matters most. A pharmacist who’s handled 200 cases of rheumatoid arthritis knows what questions to ask. A nurse who’s called a patient every month for a year can spot a problem before it becomes an emergency.

Bottom Line: It’s Not About Brand or Generic - It’s About Complexity

Providers aren’t choosing specialty pharmacies because they’re forced to. They’re choosing them because they work. Whether the drug costs $50 or $5,000, if it requires training, monitoring, or special handling - it belongs in a specialty pharmacy.

The role of the provider is evolving. It’s no longer just about diagnosis and prescription. It’s about navigating systems, advocating for patients, and ensuring continuity of care - even when the drug label says “generic.”

The future of specialty pharmacy isn’t about replacing brand drugs. It’s about making sure every patient - no matter what they’re taking - gets the right support at the right time. And that’s something no retail pharmacy can replicate.