Specialty Pharmacies

Specialized - or biotech - drugs for the treatment of diseases like multiple sclerosis, hepatitis C, and rheumatoid arthritis are costly and use and administration is often complicated.

The specialty pharmacy network helps to manage the rising cost of self-administered medications by using specialty pharmacies that monitor and distribute these high-cost medications. It also provides the services of dedicated pharmacists who are available for education and counseling and web-based patient educational programs.

The specialty pharmacies that participate in our network offer clinical resources to you and your staff, while also providing the convenience of a single contact to coordinate care and delivery.

Certain prescription drug benefits require that select self-administered specialty medications (covered under the pharmacy benefit) must be purchased from one of our participating specialty pharmacies in order to receive coverage under the prescription drug benefit. View a list of specialty medications that must be purchased through the specialty pharmacy networkOpen a PDF. 

If you wish to use a specialty pharmacy as an alternative to buying and billing a medical specialty drug that will be office administered (covered under the medical benefit), you must use one of our contracted specialty pharmacies. Our contracted specialty pharmacies will bill the member’s medical plan directly and ship the medication to the office for administration. 

Patient Enrollment

The enrollment process for new patients is simple.

  1. The patient or physician office contacts the participating specialty pharmacy to enroll. If the patient initiates contact with the specialty pharmacy, the specialty pharmacy will contact the physician office for a new prescription.
     
  2. The specialty pharmacy will contact the patient, provide disease state and drug specific education and arrange shipment of the prescribed medication.

Advantages of Specialty Rx Care Programs

  • Educational materials and programs
  • Consistent clinical monitoring
  • Compliance
  • Notification of noncompliance
  • Convenient delivery options
  • Phone and online refill ordering 
  • Dedicated pharmacists & nurses available 24/7
  • Assurances of consistent, quality supply
  • One point of contact- One single form for enrollment, prescription
  • Customer satisfaction
  • Lower medication cost 

Prescribing a Specialty Medication for Your Patient

  1. Send the prescription for the medication to the specialty pharmacy and the Prior Authorization form to Univera Healthcare
     
  2. We will review for PA while the specialty pharmacy is preparing the order and arranging delivery with the patient
     
  3. You will receive notice of determination and, if approved, the specialty pharmacy will fulfill order and complete delivery 

Network Specialty Pharmacies

Pharmacy Benefit

For drugs covered under the pharmacy benefit (self-administered), view a list of Network Specialty Pharmacies (Pharmacy Benefit). 

Please Note: MyHealthSM and MyHealth PlusSM members have the right to use a retail pharmacy in network that has agreed to accept our rates to fill their specialty drug prescriptions. They can also continue to use our specialty pharmacies (i.e., Accredo) and their drugs will be sent to their home.

To fill drugs for Managed Medicaid members covered under the pharmacy benefit (self-administered), view a list of Medicaid Managed Care Specialty Pharmacies. 

Medical Benefit

For drugs covered under the medical benefit (office administered) as an alternative to buying and billing medical specialty drugs, view a list of Network Specialty Pharmacies (Medical Benefit). 

 

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