Specialty Drugs. Charges for medications used to treat certain complex and rare medical conditions. Specialty drugs are often self-injected or self-administered. Many grow out of biotech research and may require refrigeration or special handling.
Specialty Drugs. ....means prescription drugs generally prescribed for use in limited patient populations or diseases. These drugs are typically in jected, but may also include high cost oral medications. In addition, patient support and/or education may be required for these drugs. The list of Special ty Drugs is subject to change. To determine which drugs are Specialty Drugs, you should contact your Pharmacy, refer to the Drug List by accessing the Web site at xxx.xxxxxx.xxx or call the Customer Service toll‐free number on your identification card.
Specialty Drugs. Community Health Options® has partnered with our Pharmacy Benefit Manager to implement a specialty drug program that: increases savings to our Members and the Plan; improves Member adherence; and allows Health Options’ Members 24/7 access to specialty-trained pharmacists and nurses to improve clinical outcomes. In order to pay the cost-sharing listed on your Schedule of Benefits for specialty drugs, they must be filled through our Preferred Specialty Pharmacy. The Preferred Specialty Pharmacy is established by Community Health Options and is subject to change at our discretion. These drugs are indicated on the Formulary as ‘mandatory specialty’. Specialty medications are limited to a 30-day supply, except where the medication is prepackaged and cannot be broken down into a smaller quantity. Certain specialty drugs are considered “mandatory” or “exclusive specialty” and must be filled through our Preferred Specialty Pharmacy, as defined on the Health Options Formulary. If you fill these prescriptions at a pharmacy that is not the Preferred Specialty Pharmacy, you will be responsible for 100% of the drug cost. These costs are not covered by the Plan and will not apply to your Out-of-Pocket costs. For certain specialty drugs the Plan offers one courtesy fill at a retail pharmacy as a covered benefit, as defined on the Health Options Formulary. Further fills of this specialty drug must be obtained directly through the exclusive specialty pharmacy, or you will be required to pay 100% of the allowed drug cost. In this case, the full allowed cost will apply to your Out-of-Pocket maximum.
Specialty Drugs. Caremark will be the exclusive provider of designated specialty drugs for Caremark plan participants.
Specialty Drugs. The MCO must develop policies and procedures for reclassifying prescription drugs from retail to specialty drugs for purposes of entering into selective contracting arrangements for specialty drugs. The MCO's policies and procedures must comply with 1 Tex. Admin. Code § 353.905 and § 354.1853 and include processes for notifying Network Pharmacy Providers.
Specialty Drugs. HHSC will adopt rules concerning specialty pharmacy services. Once HHSC adopts these rules, the MCO must develop policies and procedures for reclassifying prescription drugs from retail to specialty drugs. The MCO’s policies and procedures must be consistent with HHSC’s rules, and include processes for notifying Network Pharmacy Providers. As set forth in Section 8.1.4, the MCO may enter into selective contracts for specialty pharmacy services prior to HHSC’s adoption of rules concerning specialty pharmacy services, subject to the following conditions. These arrangements must comply with Texas Government Code §533.005(a)(23)(G). Furthermore, if these specialty pharmacy services contracts conflict with final rules promulgated by HHSC, then the MCO must terminate the contracts or amend them to comply with the rules.
Specialty Drugs. For more information please refer to the “Pre-certification Requirement and Prior Authorization Recommendation” section of this contract or call PIC at the phone number listed on the inside front cover of this contract.
Specialty Drugs. The TennCare pharmacy program described in this Agreement uses a rate table for Specialty Medications, defined as the Specialty Pharmaceutical Pricing List. The Specialty Pharmaceutical Pricing List is subject to periodic review by TennCare and/or PBM and may be modified at the discretion of TennCare. A link to the current Specialty Pharmaceutical Pricing List can be found at the website: xxxx://xxxxxxxxx.xxx/tenncare/pro-pharmacy.html. ABACUS # 13-228 4. RELATIONSHIP BETWEEN PARTIES
Specialty Drugs. Benefits Specialty Drugs obtained at Fairview Specialty Pharmacy or other designated specialty pharmacy. PIC pays: For more information, contact Fairview Specialty Pharmacy at 612.672.5260 or 0.000.000.0000. NOTE: Certain specialty drugs may only be available by limited distribution through the manufacturer’s select specialty pharmacy and may not be available through Fairview Specialty Pharmacy. Benefits for such limited distribution specialty drugs will be paid the same as if they were obtained from Fairview Specialty Pharmacy. Specialty Drugs obtained at any pharmacy other than a designated specialty pharmacy: • Specialty drugs up to a 31– calendar day supply per prescription or refill that: may be oral or injectable; and Must be purchased through a specialty pharmacy. A list of these specialty drugs may be obtained on PIC’s website or by calling PIC Customer Service. The list of specialty drugs may be revised from time-to-time without notice. NOTE: Prescription drugs which PIC determines are specialty drugs will not be covered at the tier 1 generic, tier 2 generic, preferred brand or mail order benefit level. Tier 1 Generic: 50% of eligible charges after the deductible. Tier 2 Generic: 50% of eligible charges after the deductible. Preferred Brand: 50% of eligible charges after the deductible. Non-Preferred Brand and Non-formulary: Not covered. Not covered.
Specialty Drugs. The mail order pharmacy for specialty drugs is Walgreens Specialty Pharmacy, LLC, an independent company. Specialty prescription drugs (such as Enbrel® and Humira® ) are used to treat complex conditions such as rheumatoid arthritis. These drugs require special handling, administration or monitoring. Walgreens Specialty Pharmacy will handle mail order prescriptions only for specialty drugs while many retail pharmacies will continue to dispense specialty drugs (check with your local pharmacy for availability). Other mail order prescription medications can continue to be sent to Medco. (Medco is an independent company providing pharmacy benefit services for Blues members.) A list of specialty drugs is available on our Web site at xxxxx.xxx. Log in under “I am a Member.” If you have any questions, please call Walgreens Specialty Pharmacy customer service at 0-000-000-0000. BCBSM reserves the right to limit the initial quantity of select specialty drugs. Your copay will be reduced by one-half for this initial fill (15 days). Member’s responsibility (copays) Network pharmacy Non-network pharmacy Generic prescription drugs $15 copay for each prescription $15 copay for each prescription plus an additional 25% of BCBSM approved amount for the drug Prescribed over-the-counter drugs – when covered by BCBSM Note: Over-the-counter (OTC) drugs are drugs that do not require a prescription under federal law $15 copay for each prescription $15 copay for each prescription plus an additional 25% of BCBSM approved amount for the drug Brand name prescription drugs $30 copay for each prescription $30 copay for each prescription plus an additional 25% of BCBSM approved amount for the drug Mail order (home delivery) prescription drugs Copay for up to a 90 day supply: • $15 copay for each generic drug • $30 copay for each brand name drug No coverage Note: If your prescription is filled by any type of network pharmacy, and you request the brand-name drug when a generic equivalent is available on the BCBSM MAC list and the prescriber has not indicated “Dispensed as Written” (DAW) on the prescription, you must pay the difference in cost between the brand-name drug dispensed and the maximum allowable cost for the generic plus the applicable copay.
