For many individuals living with cancer, treatment now comes in the form of specialty drugs. Considered particularly complex, these drugs tend to carry high price tags and require distribution through specialty pharmacies. When generics enter the specialty market, they are expected to reduce patient costs, but this is not always the case. We recently transitioned a patient from a brand-name specialty drug to a specialty generic (SG), and the out-of-pocket (OOP) cost rose. This patient with metastatic cancer and commercial insurance had been treated with brand-name fulvestrant for more than 1 year. The cost was more than $4000 per month, with an OOP responsibility of several hundred dollars. However, enrollment in the manufacturer’s drug assistance program reduced the OOP to less than $20 per month. When generic fulvestrant became available, we transitioned the patient to it and expected to reduce costs for everyone. To our surprise, the generic OOP cost was close to $2000 a month, which led to a co-pay debt of almost $8000 after 4 months. We realized that patients using specialty drugs can be exposed to greater financial risk when the generic enters the market—a period where there is a lack of an affordable generic (LAG).