Why Do Some Medications Need to Be Administered By Your Healthcare Provider?
Key takeaways:
Certain medications need to be given by a healthcare provider (HCP). These are sometimes called HCP-administered medications. This is usually to ensure that the medication is given correctly or to manage potential side effects.
Injections and infusions are the most common types of HCP-administered medications. Examples include Leqembi (lecanemab) for Alzheimer’s disease and Reclast (zoledronic acid) for osteoporosis.
Most insurance plans cover HCP-administered medications. But how you pay for them depends on your plan and how your provider gets the medication.
When your healthcare provider (HCP) writes you a prescription, you’re probably used to picking it up from your local pharmacy. But there are some medications that you can’t administer yourself. And others may also require close monitoring due to potentially serious side effects.
In this case, you may need to receive your medication in a medical setting rather than at home. These are sometimes called HCP-administered drugs. Injections and infusions are common examples. But certain other medications with different dosage forms, including nasal sprays like Spravato (esketamine) and topical solutions like Ycanth (cantharidin), also need to be administered by an HCP.
Below, we’ll talk about medications administered by a healthcare provider, including what they are, why they can’t be taken at home, and how insurance works with these medications.
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What are HCP-administered drugs?
HCP-administered drugs are medications that need to be given by a trained healthcare professional. They often have complex dosing regimens, require special handling, or need to be administered in a specific way, such as an injection or infusion. Your healthcare provider may also need to monitor you for rare, but serious, side effects.
For example, some chemotherapy drugs used in cancer treatment can cause severe side effects. They need to be administered in precise doses, at specific times, and often in combination with other medications.
What are the different types of HCP-administered medications?
HCP-administered medications come in various forms. They’re also used to treat a wide range of conditions. Injections and infusions are the most common types of HCP-administered medications.
Injections: Injections are delivered either under the skin (subcutaneously) or into the muscle (intramuscularly). Examples include vaccines and some biologic medications used to treat arthritis and other chronic conditions.
Infusions: These medications are administered into the vein (intravenously), usually over a period of time. Chemotherapy drugs, some antibiotics, and some medications for autoimmune disorders are a few examples.
As mentioned above, certain nasal sprays and topical solutions are also administered in a medical setting. Examples include Spravato for depression and Ycanth for molluscum (a viral skin infection).
Good to know: There are also some medications that you may be able to give yourself at home. But you may need to receive the first dose (or first few doses) at your provider’s office. This may be done to see how you respond to the medication and ensure you’re able to administer it properly. Examples include Xolair (omalizumab) and Humira (adalimumab).
Examples of HCP-administered drugs
More examples of HCP-administered drugs include:
Leqembi (lecanemab): Leqembi is an infusion for Alzheimer’s disease that’s infused over the course of about an hour. People receiving it are also monitored for infusion-related reactions during this time.
Reclast (zoledronic acid): Reclast is an infusion for osteoporosis and Paget’s disease. It’s infused over a period of at least 15 minutes.
Beyfortus (nirsevimab-alip): Beyfortus is an injectable medication for respiratory syncytial virus (RSV) prevention in babies and certain young children. Children will typically receive Beyfortus at their HCP’s office.
Zulresso (brexanolone): Zulresso is a one-time infusion for postpartum depression. It’s infused over the course of 60 hours. People receiving it are also monitored for extreme drowsiness from the medication during this time.
Abilify Maintena (aripiprazole): Abilify Maintena is an extended-release injection for schizophrenia and bipolar 1 disorder. A healthcare provider injects it into a muscle every month.
Zyprexa Relprevv (olanzapine): Zyprexa Relprevv is an injection that can cause serious delirium (sudden confusion) and sedation afterwards. Because of this, people receiving it must be monitored for at least 3 hours after administration.
Why must some medications be administered by a healthcare provider?
Most commonly, medications may need to be administered by a healthcare provider due to unique risks related to how they’re given, handled, or prepared. For example, some may need to be infused over a period of time or mixed before using. Others may involve a high-risk procedure, such as a spinal or epidural injection, that can only be done by a healthcare provider.
HCP-administered medications may also have potential complications, such as allergic reactions or severe side effects. While uncommon, these often happen during or right after administration. In this case, a healthcare provider is best equipped to manage any problems that may arise.
Keep in mind that these aren’t the only reasons that a medication may need to be administered by a healthcare provider.
Does insurance cover HCP-administered drugs?
Most health insurance plans cover HCP-administered drugs, especially if they’re deemed medically necessary. However, you may still be responsible for a copayment, coinsurance, or deductible, depending on your plan. Review your benefits and consult with your insurance provider for detailed information.
The way your insurance company is billed — under your medical or pharmacy benefit — also depends on how your healthcare provider gets the medication. There are a few different ways they can do this, including:
Buy and bill: Your healthcare provider buys the medication directly from a drug distributor. They’ll bill your insurance, and you’ll pay them any out-of-pocket costs.
White bagging: Your healthcare provider sends a prescription to a specialty pharmacy. The specialty pharmacy bills your insurance and mails the medication to your provider’s office.
Brown bagging: Your healthcare provider sends a prescription to a pharmacy. You pick the medication up from the pharmacy (or they ship it to you) and you bring it to your provider’s office.
Many HCP-administered drugs are considered specialty medications. In this case, the approval process is often handled by your HCP or a specialty pharmacy behind the scenes. If a medication isn’t covered or is too expensive, they may be able to help you find patient assistance programs or alternative treatments.
The bottom line
There are several reasons a medication needs to be administered by a healthcare provider. HCP-administered drugs are often injections or infusions that are more complex to give. They may also require monitoring for any serious side effects that can occur during or shortly after administration.
Your healthcare provider can get the HCP-administered medication a few different ways, including from a drug distributor, a specialty pharmacy, or a local retail pharmacy. Sometimes, they’ll have it in the office for you. Other times, you’ll need to bring it with you to your appointment. Typically, your insurance coverage will dictate where the medication comes from.
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References
Pearson, C., et al. (2023). White bagging, brown bagging, and site of service policies: Best practices in addressing provider markup in the commercial insurance market. Institute for Clinical and Economic Review.
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