From 2003 to 2014 the proportion of specialty prescription drugs (defined as those reimbursed at $600 or more per thirty-day fill) nearly quadrupled. Over this time period, fills for specialty drugs increased by 198 percent and spending for the drugs increased by 292 percent, as percentages of total drug fills and spending. Median out-of-pocket spending increased by 46 percent for specialty drugs and decreased by 57 percent for nonspecialty drugs during this time.