OBJECTIVES:  Care for children with medical complexities represents a significant challenge for health care systems and has emerged as an increasingly important component of pediatric practice. A pediatrician-led care coordination may increase the quality of care for medically complex children. We examined the prescription utilization and cost patterns of children with special healthcare needs having complex chronic conditions. METHODS:  This was a retrospective secondary analysis of prescription utilization and costs using Texas Medicaid administrative claims data for patients with complex chronic conditions (N=229) who were enrolled in the Specially for Children pilot study and patients with complex chronic conditions not enrolled in the Specially for Children pilot study. Daily dispense cost was determined by dividing amount paid for a claim by its corresponding days supply. Descriptive statistics were used for determining the costliest and most frequently paid drug claims. RESULTS:  A total of 229 patients with 24,478 drug claims were included in the study. The average cost per prescription was $443. The costliest drug claim had a daily dispense cost of $5,706 (HP Acthar Gel 80 unit/ml) with the top ten ranging from $5,706 to $1,454. Average daily dispense cost of the ten most frequent drug claims ranged from $0.57 to $10.30. The AHFS category with the highest attributed cost was for hemostatic agents ($2,085,711, N=55 prescriptions). The most frequent paid drug claim was levetiracetam 100mg/ml solution (N=715). Additionally, AHFS category anticonvulsants, miscellaneous accounted for the most drug claims (N=846). Of the ten costliest AHFS categories, enzymes had the highest average cost per claim ($41,358, N=18). CONCLUSIONS:  We found the ten most expensive drugs to all exceed a daily dispense cost of $1,450. The next step is to compare differences in prescribing trends and costs between the pediatrician-led model and usual care model.