Specialty Medications
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:
- Anemia
- Asthma
- Growth Hormone Deficiency
- Hemophilia
- Hepatitis C
- Multiple Sclerosis
- Rheumatoid Arthritis
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
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:
- An on-call pharmacist to answer questions 24 hours a day, 7 days a week
- Personalized counseling from a team of registered nurses and pharmacists
- Coordination of home care and other health care services, when appropriate
- Expedited, scheduled delivery of your medications at no additional cost
- Refill reminder call
It's easy to get started using Accredo. There are two options to contact Accredo:
- OPTION 1 — Call Accredo Specialty Pharmacy:
- Step 1: Call Accredo toll-free at 877-988-0059 between 8 a.m. and 8 p.m., Eastern Time, Monday through Friday.
- Step 2: Accredo will contact your provider and start the pharmacy transition arrangements so that you can continue receiving the medications you need.
- Step 3: Accredo will call you back to arrange delivery of your medications at a time that is convenient for you.
- OPTION 2 — Have your provider call:
- Step 1: Give your provider your member ID number (shown on your State Health Plan ID card), and ask him or her to call 800-987-4904. Your provider may also order your specialty medication by accessing the Accredo website, completing the condition specific form with the requested information, and then faxing the completed form to Accredo.
- Step 2: Accredo will call you back to arrange for expedited delivery of your medications at a time that is convenient for you.
To learn more about Accredo, call 877-988-0059 or visit the Accredo website.
