Many complex conditions are treated with specialty medications. Specialty medications are FDA approved drugs that are typically injectable medications administered either by you or a health care professional, and they often require special handling. Conditions commonly requiring specialty medications include:
The Centers for Medicare and Medicaid Services (CMS) approves the specialty drug list for the Express Scripts Medicare™ Prescription Drug Plan. Please refer to the Specialty Drug List. The medications included on this list are different than the Traditional Pharmacy Plan.
Specialty medications are Tier 4 medications and are subject to a 25 percent coinsurance up to a $100 maximum for a 31 day supply. Many specialty medications require prior authorization. To obtain a prior authorization, you, your appointed representative, or your prescriber can request prior authorization by calling Express Scripts Medicare™ Prescription Drug Plan at 800-935-6103. Providers can also visit www.medco.com/coverage.
Specialty medications may be obtained at any in-network retail pharmacy, as well as Accredo.
Accredo, the State Health Plan's specialty pharmacy, deals exclusively with supplying medications to treat complex conditions and provides a high level of care for patients with chronic or serious conditions, who take medications that require injection, special handling and monitoring.
Services provided by Accredo include:
It's easy to get started using Accredo. There are two options to contact Accredo:
Explore My Express Scripts Medicare Prescription Drug Plan