Does CapitalRx Have a Program for Orphan Drugs?

CapitalRx does not currently have a dedicated program that identifies orphan drugs, and they are not flagged as such in the formulary.

Most orphan drugs are:

• Healthcare-administered (given in a clinical or hospital setting rather than at home)
• High-cost and specialty in nature
• Difficult to source through standard pharmacy channels

Because of this, orphan drugs typically run through the medical benefit rather than the pharmacy benefit. This allows them to be managed in coordination with providers, facilities, and stop loss carriers.

Key takeaway: Orphan drugs are not specifically labeled or managed through CapitalRx’s formulary—they are generally handled under the medical benefit due to their cost and administration requirements.