Exclusive Specialty Pharmacy a program that requires plan members to purchase specialty medications through the pharmacy benefit manager’s exclusive specialty pharmacy arrangement. Any medication that the pharmacy benefit manager (“PBM”) does not designate as a specialty medication is not subject to this requirement. In instances where the specialty medication is not available at the PBM’s specialty pharmacy, the PBM shall coordinate purchasing arrangements with another specialty pharmacy within the PBM’s network. At the member’s request, the pharmacy benefit manager will deliver the specialty medication to the member’s home, the member’s physician’s office, or to a retail pharmacy of the member’s choosing that is part of the PBM’s pharmacy network.15
Exclusive Specialty Pharmacy j. A Smoking Cessation Program will be established effective October 1, 2010.
