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. 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 Community 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 Community 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 Community 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. ....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. 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.
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. CHLIC shall process Claims regarding Specialty Drugs subject to the following provisions: (1) The Specialty Pharmacy shall fill prescriptions for Specialty Drugs based on the professional judgment of the dispensing pharmacist, accepted pharmacy practices and product guidelines. (2) A list of Specialty Drugs available via the Specialty Pharmacy and pricing with respect thereto shall be made available as in effect on the Effective Date, are set forth in Appendix B. After the Effective Date, Employer may request that CHLIC provide it with an updated list of Specialty Drugs available via the Specialty Pharmacy and pricing with respect thereto. (3) To the extent acting in the capacity as a mail order pharmacy, the Specialty Pharmacy shall ship Specialty Drugs to Members in accordance with its standard procedures. (4) Members are responsible for payment of the applicable cost sharing to the Specialty Pharmacy for each prescription or prescription refill. Employer acknowledges that the Specialty Pharmacy may suspend services to a Member who is in default of any cost-sharing obligations, in accordance with the Specialty Pharmacy’s standard credit policy. If payment has not been received from the Member within one hundred twenty (120) days of dispensing, the Plan will be billed following the one hundred twenty (120) day collection period. (5) For the purposes of clarity, CHLIC does not exert direction or control over the pharmacists at the Specialty Pharmacy in filling prescriptions or performing other pharmaceutical services.
