What constitutes a specialty drug in Medicaid's tier system?

A specialty drug in Medicaid's tier system is characterized by high costs and the need for special handling or administration due to its complexities. These drugs often treat complex or chronic conditions, such as rheumatoid arthritis, multiple sclerosis, or certain types of cancer, and may require special storage, monitoring, or administration by healthcare professionals.

The designation as a specialty drug reflects the unique challenges associated with these medications, including their cost, potential side effects, and the necessity for patient education and adherence support. This helps ensure that patients receiving these therapies have access to the appropriate services and monitoring that can optimize their treatment outcomes.

The alternatives do not fit the definition of specialty drugs. Generic drugs are typically lower-cost medications that do not require special handling, preferred brand name drugs are brand medications deemed more cost-effective but do not carry the specific criteria for specialty classification, and over-the-counter medications are drugs available without a prescription that generally do not fall into the specialty category.