Specialty Pharmacy Frequently Asked QuestionsWhat are Specialty Pharmacy Medications? Why is Synagis considered a Specialty Pharmacy Medication? Where can a list of the Specialty Pharmacy Medications be obtained? Do I have to obtain my Specialty Pharmacy Medication from Caremark Specialty Pharmacy Services? What free-of-charge services are offered by Caremark Specialty Pharmacy Services? Will changing to Caremark Specialty Pharmacy Services result in a change in my co-pay? What do I need to do if I am on a Specialty Pharmacy Medication that requires Prior Authorization?
What are Specialty Pharmacy Medications?Specialty Pharmacy Medications are medications manufactured often using highly specialized techniques. They were developed to manage or prevent symptoms associated with long term chronic disease states. Many of these medications require frequent clinical monitoring due to side effects. The medication may be self injected or given orally. Specialty Pharmacy Medications also include medications that cannot be stocked at a local retail pharmacy. Why is Synagis considered a Specialty Pharmacy Medication?Synagis is a very costly medication that is only given on a seasonal basis to premature infants who are at high risk of developing RSV (Respiratory Synctial Virus). These infants must meet specific criteria developed by the American Association of Pediatric Physicians in order to receive the medication. Close clinical monitoring is required. Are Specialty Pharmacy Medications considered retail medications or mail order medications since they are mailed?Although Specialty Pharmacy Medications are "mailed", such as to the physician's office or to the patient's home, they are considered a retail medication because only a 30 day supply of the medication can be dispensed. Mail order medications can be dispensed as a 90 day supply. Where can a list of the Specialty Pharmacy Medications be obtained?A list of the Specialty Pharmacy Medications can be found on the Coventry Health Care website at www.chcnebraska.com. Do I have to obtain my Specialty Pharmacy Medication from Caremark Specialty Pharmacy Services?No. Being a Coventry Health Care member, you have a choice regarding what pharmacy you would like to obtain your medication from. Utilizing Caremark Specialty Pharmacy Services will, however, maximize your benefit dollars as well as provide some free-of-charge services to Coventry Health Care's members. What free-of-charge services are offered by Caremark Specialty Pharmacy Services?These providers offer timely, accurate and free courier delivery of medications to your home, your office, your vacation spot, or your doctor's office - typically within 24 to 48 hours. Additionally, they offer:
Will changing to Caremark Specialty Pharmacy Services result in a change in my co-pay?If you are currently using an out of network provider switching to Caremark's Specialty Pharmacy may decrease the amount of your co-pay. Please note that benefits are policy specific. For more information regarding co-payment amounts please contact the Coventry Health Care Customer Service number on the back of your Coventry Health Care ID card. What do I need to do if I am on a Specialty Pharmacy Medication that requires Prior Authorization?Contact the Coventry Health Care Customer Service number on the back of your Coventry Health Care member identification card. If I have a drug card through Coventry Health Care will a Specialty Pharmacy Medication be able to be obtained using the card?Yes, but only if the medication is being provided by a Coventry Health Care participating pharmacy or participating Specialty Pharmacy Provider. If my physician's office is going to provide the Specialty Pharmacy Medication will I still be able to use my drug card?No. Physician's offices do not have the capabilities to submit charges under a member's drug card. The physician's office would submit the claim and the claim would be processed under the Major Medical provision of the member's policy. Who may I contact for questions concerning the handling of a request for a Specialty Pharmacy Medication?Contact Caremark Specialty Pharmacy Services at 1-800-237-2767. |