The Specialty Pharmacy Drug Program
What is the Specialty Pharmacy Drug Program?
- The MA Program is contracted with two (2) nationally recognized specialty pharmacies, through the competitive bidding process, to serve as the MA Program’s preferred providers for specialty drugs.
- Preferred provider means that when an MA client is prescribed a specialty drug, the MA client must obtain that drug from one of the Department‘s preferred providers.
- The preferred providers dispense specialty drugs and offer specialized services to support patients who take specialty drugs.
Who is impacted by the Specialty Pharmacy Drug Program?
The program applies to MA clients:
- Whose pharmacy services are covered under the Fee-for-Service (FFS) delivery system, and
- Who use the MA Program ACCESS card to get their pharmacy services
The program does not apply to the following MA clients:
- Who are enrolled in a Medicaid managed care organization; or
- Whose specialty medications are covered by Medicare Part B or Part D or by a private health plan policy UNLESS those programs/policies/plans do not cover the specialty drug and the drug is covered by the Pennsylvania Medical Assistance Program. In that case, this program does apply.
Specialty Pharmacy Drug Program preferred providers
The two specialty pharmacy preferred providers are:
What are Specialty Drugs?
Specialty drugs include oral and injectable medications that:
- Are used to treat chronic and life-threatening diseases
- Are expensive
- Are difficult to administer
- May cause adverse reactions
- Require temperature control or other specialized handling
Specialty Drug List
What services do the specialty pharmacy providers offer?
The specialty pharmacy providers will:
- Contact you to ask you some questions to learn more about you and to plan for support services, such as nurses, that you may need while taking the specialty drug.
- Contact you about 10 days prior to your refill date to see if there have been any changes in your therapy and set up a specific date for delivery.
- Deliver your specialty drug. This can be the doctor’s office, a clinic, a treatment center, or your home or other designated location.
- Teach you and your caretaker how to use your specialty drug if your or a caregiver will be administering.
- Coordinate with home nursing services if your doctor determines that the specialty drug must be administered by a nurse.
- Provide training and information about your specialty drug including how to properly handle and store your drug, possible side effects and how to handle side effects, etc.
- Provide a toll-free, patient call center run by the specialty pharmacy provider that is available 24 hours a day, 7 days a week to answer any medical questions you may have about your specialty drug.
- Monitor for drug interactions.
Additional benefits include:
- No co-payments for specialty drugs
- Free shipping
- Free administration supplies
- You can continue to get all non-specialty drugs at the pharmacy you usually use
How will I get my Specialty Drug?
- Talk with your doctor to decide which specialty pharmacy provider to use. Your doctor can order your prescription by phone or fax.
- The specialty pharmacy will call you to arrange for the delivery of the specialty drug to the location you and your doctor specify, which could include your doctor’s office, a clinic, treatment center, your home or work.
- If you are currently getting your specialty drug from a non-preferred pharmacy, you can contact the preferred specialty pharmacy directly and ask them to contact your doctor to get a prescription.
- The specialty pharmacy will coordinate nursing services if needed. You can choose to use the specialty pharmacy’s nursing services or any MA enrolled home health provider.
English Version - Specialty Pharmacy Drug Program
Versión en Español - Programa de Especialidades Farmacéuticas