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Written by Aubrey Hersch, PharmD, Director of Clinical Accreditation
Starting a specialty medication may involve insurance approval, medication education, delivery or infusion scheduling, and ongoing clinical support. Understanding the process can help you feel more prepared before treatment begins.
Specialty medications are prescribed for complex, chronic, or rare conditions. The process involves more steps than simply filling a routine prescription; our staff coordinates activities such as insurance approval, medication education, specific laboratory results, delivery arrangements, infusion scheduling, and continuous follow-up.
The time required to begin therapy varies depending on the medication, insurance requirements, and clinical documentation needed from your provider.
Some therapies may begin within days, while others may take several weeks if prior authorization or appeals are required, or if additional medical records or laboratory results are needed.
Soleo Health helps patients understand each step before therapy begins and during treatment.
Specialty medications are therapies used to treat complex, chronic or rare conditions. These can include autoimmune disorders, neurological conditions, immune deficiencies, inflammatory conditions and gastrointestinal diseases.
These medications often have requirements or considerations that differ from traditional prescriptions, including:
Because of these factors, specialty medications are often managed through a specialty pharmacy. A specialty pharmacy helps coordinate the medication, education, insurance steps and clinical support related to therapy.
It may be self-injected, delivered to your home or administered through home or center-based infusion.
Your care team can review insurance coverage, expected out-of-pocket costs and available financial assistance.
Your pharmacist, nurse, care coordinator or prescribing provider can help based on the situation
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Before therapy begins, many specialty medications require prior authorization. During prior authorization, the insurance plan reviews whether the medication meets coverage requirements.
Your specialty pharmacy works with your provider and insurance plan to help move this process forward.
During this stage, your care team may help with:
If coverage is denied by your insurance company, your care team may work with your provider to submit additional information, request reconsideration, or explore available financial assistance programs when appropriate.
Soleo Health keeps patients informed throughout the process by explaining next steps, identifying any additional information needed and reviewing expected out-of-pocket costs before treatment begins.
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After approval, your care team explains what the medication does, how it is administered and what you can expect during treatment.
Our clinical team can answer questions before your first dose, so you know what to expect and how to prepare.
You’ll receive education and support on topics such as:
How your medication is provided depends on your prescribed therapy and individual care plan.
Depending on your treatment, your medication may be:
Some specialty medications require temperature control, careful handling or specific timing. Your care team coordinates delivery or scheduling so you know when therapy will begin and what steps you need to take before your appointment or first dose.
It is important to know when your delivery is arriving so you can promptly retrieve your medication and store it at home as instructed. This is especially important during warm summer months and cold winter days.
Support does not stop once therapy begins. Depending on the medication and treatment plan, your care team may continue to provide:
Soleo Health’s clinical team, including pharmacists, nurses and care coordinators, supports patients throughout therapy. Our team is available to answer questions about medication, administration, side effects, or treatment plans.
Patients’ response to therapy can vary, with some patients experiencing a quick benefit from the therapy, and for other patients, it may take several doses to see a response.
Our clinical team can offer suggestions for managing side effects or encouraging patients to follow up with their prescriber to share how they are feeling on the therapy.
As treatment progresses, your provider may make changes to your medication, dosing schedule or overall treatment plan based on how you are responding to therapy.
If adjustments are needed, your specialty pharmacy can help coordinate the transition. This may involve updating insurance approvals, arranging medication delivery, modifying infusion appointments, or providing additional education about the changes to your care plan.
The time required to begin treatment depends on the medication, insurance requirements and the clinical documentation needed from your provider. Some therapies may begin within a few days, while others may take several weeks if prior authorization, appeals, medical records or laboratory results are required.
Many specialty medications require prior authorization because your insurance plan must confirm that the treatment meets its coverage requirements. Your provider and specialty pharmacy may need to submit clinical information, medical records or laboratory results before the medication is approved.
Yes. Your specialty pharmacy can help verify your insurance benefits, review expected out-of-pocket costs, coordinate with your provider and support the prior authorization process. When available, the care team may also help identify copay assistance or manufacturer support programs.
Depending on your prescribed therapy and care plan, your medication may be shipped directly to your home. Your care team will provide instructions for receiving, handling and storing the medication. It is important to retrieve delivered medication promptly, especially during very hot or cold weather.
Depending on your medication and care plan, infusion therapy may be provided at an ambulatory infusion center or in your home by a trained infusion nurse. Your care team will help coordinate the location and scheduling of your treatment.
Contact your Soleo Health clinical care team or prescribing provider if you experience side effects or changes in how you are feeling. Pharmacists, nurses and care coordinators can answer questions, offer guidance for managing certain side effects and help determine when you should follow up with your provider.
Contact your Soleo Health care team as soon as possible if your insurance coverage changes. The team can review your updated benefits, determine whether new authorization is required and help coordinate the next steps to avoid unnecessary treatment delays.
Soleo Health continues to support patients throughout therapy with clinical check-ins, side-effect and symptom monitoring, refill coordination, medication adherence support and communication with the prescribing provider when needed. The care team can also help coordinate changes to medication, dosing, delivery or infusion scheduling.
If you have questions about starting a specialty medication, Soleo Health can help explain the process, review expected costs and guide you through the next steps.
Soleo Health helps coordinate care across insurance, pharmacy, nursing and provider communication. Our Patient Access team helps coordinate insurance verification, prior authorization and start-of-care steps so patients and providers understand what is needed before therapy begins.
Aubrey Hersch, PharmD
Director of Clinical Accreditation
Aubrey Hersch has found her calling at Soleo Health, where she’s spent the past three years growing from patient care to a leadership role that impacts clinicians nationwide.
This content is for educational purposes only and is not intended to replace medical advice from your healthcare provider.