As the end of each month nears, Megan Short frets. Her 1-year-old daughter, Willow, cannot afford to miss even a single dose of a drug she takes daily to prevent her body from rejecting her transplanted heart.
Because of stringent rules from her drug plan and the pharmacy she is required to use, Ms. Short cannot order a refill until her monthly supply is three-quarters gone. Yet processing a refill takes about seven days, making it touch and go whether the new shipment will arrive before the old one runs out.
"You just feel like every month, you're hoping that they don't mess it up," said Ms. Short, who lives in this town about 70 miles northwest of Philadelphia.
Ms. Short is not dealing with her corner drugstore but with a so-called specialty pharmacy, a new breed of drug dispensary that has arisen to handle the exploding number of medicines that cost tens or hundreds of thousands of dollars a year and are used to treat complex or rare diseases like cancer, rheumatoid arthritis, hemophilia and H.I.V.
Such specialty medications, as they are called, now account for one-third of all spending on drugs in the United States, up from 19 percent in 2004 and heading toward 50 percent in the next 10 years, according to IMS Health, which tracks prescriptions.