Specialty Drugs definition

Specialty Drugs means high-cost injectables, infused, oral, or inhaled Prescription Drugs for the ongoing treatment of a chronic condition, including but not limited to, the following: Hemophilia, Hepatitis C, Multiple Sclerosis, Rheumatoid Arthritis, Psoriasis, Crohn’s Disease, Cancer (oral medications), and Growth Hormones. These Prescription Drugs usually require specialized handling (such as refrigeration). Spouse means a person of the same or opposite sex who is legally married to Subscriber under the laws of the state or jurisdiction in which the marriage took place. A marriage legally entered into in another jurisdiction will be recognized as a marriage in the District of Columbia.

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Specialty Drugs means drugs listed on the Approved Drug List meeting certain criteria, such as:

Specialty Drugs means high-cost prescription medications used to treat complex, chronic conditions including, but not limited to cancer, rheumatoid arthritis and multiple sclerosis. Specialty Drugs often require special handling (like refrigeration during shipping) and administration (such as injection or infusion). Please contact the Prescription Drug Plan Administrator to determine specific drug coverage.

Examples of Specialty Drugs in a sentence

• For Specialty Drugs that are self-administered, you must obtain the Specialty Drugs from a designated vendor to be covered as Network Benefits.

• Specialty Drugs may be provided by Prime, an affiliate of Prime, or other specialty pharmacy that has a written arrangement with Prime or Claim Administrator.

• Specialty Drugs are not covered under the medical benefits even if they are administered in a Physician’s office.

• Tier 4 Drugs (Specialty Drugs) are identified in the Essential Drug List with “SP,” require Prior Authorization from Health Net and may be required to be dispensed through the specialty pharmacy vendor to be covered.

• Retail Pharmacy (up to a 30- day supply) Participating Pharmacy Nonparticipating Pharmacy Retail Pharmacy (up to a 30- day supply) Participating Pharmacy Nonparticipating Pharmacy Tier 4 (Specialty Drugs) (up to a 30-day supply) Specialty Pharmacy Vendor Maintenance Drugs through the Mail Order Program (up to a 90- day supply) Mail Order Program Note(s): You will be charged the applicable Deductible, Copayment or Coinsurance for each Prescription Drug Order.

More Definitions of Specialty Drugs

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 ▇▇▇.▇▇▇▇▇▇.▇▇▇ or call the Customer Service toll‐free number on your identification card.

Specialty Drugs mean those scientifically engineered Covered Medications deemed specialty by SOUTHERN SCRIPTS used to treat certain complex and rare medical conditions and are often self-injected or self-administered, which are set forth on Exhibit “B” and may be updated periodically by SOUTHERN SCRIPTS. Claims shall be priced at either the lower of (a) Usual and Customary OR (b) the applicable price formula described below:

Specialty Drugs means Prescription Drugs generally prescribed for use in limited patient populations or diseases. These drugs are typically injected, but may also include drugs that are high cost oral medications and/or that have special storage requirements. In addition, patient support and/or education may be required for these drugs. The list of Specialty Drugs is subject to change. To determine which drugs are Specialty Drugs, a Covered Person should contact his/her Pharmacy, refer to the Drug List by accessing the website at www.bcbsil.com or contact customer service at 1-855-267-0214.

Specialty Drugs means a high cost prescription drug that meets any of the following criteria:

Specialty Drugs means prescription drugs generally prescribed for use in limited patient populations or diseases. These drugs are typically injected, but may also include drugs that are for serious or chronic conditions, oral medications and/or that have special handling or storage requirements, or are infused medications. In addition, patient support and/or education may be required for these drugs. The list of Specialty Drugs is determined by Prime or Claim Administrator and subject to change.

Specialty Drugs means those covered drugs that typically are high in cost and have one or more of the following characteristics: 1) complex therapy for complex disease; 2) specialized patient training and coordination of care (services, supplies, or devices) required prior to therapy initiation and/or during therapy; 3) unique patient compliance and safety monitoring requirements; 4) unique requirements for handling, shipping and storage; and 5) potential for significant waste due to the high cost of the drug. In addition, a follow-on-biologic or generic product will be considered a Specialty Drug if the innovator drug is a Specialty Drug.

Specialty Drugs means high-cost injectables, infused, oral or inhaled Prescription Drugs that: