Frequently Asked Questions
Prior Authorization Programs beginning 11/1/08 for New Users of Medications Treating:
- Psoriasis (Amevive and Raptiva)
- Multiple Sclerosis (Betaseron, Rebif, Copaxone, Avonex, and Tysabri)
- Diseases caused by abnormalities of the immune system and Multiple Myeloma (Thalomid and Revlimid)
- Why did the State Health Plan make this change to the prescription benefits?
- What do I have to do to obtain this prior authorization?
- Is there a Web site I can visit that offers more information?
- Will current users of these medications be required to obtain a prior authorization?
- Are copays changing for these medications?
- How long is the approval valid for these types of medications?
- Can Medco provide these injectable and specialized medications?
- How do I access Accredo Specialty Services?
- Whom should I call with questions regarding the prior authorization programs?
These new prior authorization (PA) programs are being put into place primarily for safety reasons. We want to ensure that the medications are safe and effective for members. The PA programs will also align these medications with the prior authorization requirements for other specialty medications for Rheumatoid arthritis and asthma.
Back to topWhat do I have to do to obtain this prior authorization??
Current users of these medications will not be subject to the prior authorization program. New users should have their providers contact Medco for prior authorization.
Is there a Web site I can visit that offers more information?
Program information is located on the pharmacy prior authorization policy Web page at.
Will current users of these medications be required to obtain a prior authorization?
No, current users will not be required to obtain a prior authorization for any prescription renewals.
Are copays changing for these medications??No, these specialty medications will continue to be covered at the current $50 copay.
How long is the approval valid for these types of medications?
The approval times vary, depending on the medication. Please refer to the Prior Authorization (PA) policies Web page for details.
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Can Medco provide these injectable and specialized medications?
Yes, these medications are available through Medco’s specialty pharmacy, Accredo. Accredo offers members:
- Training on how to mix, store and self-inject specialty drugs
- Education on how to respond to side effects and how to manage complex dosing schedules required by many specialty drugs
- Access to specialty pharmacists and nurses 24 hours a day, 7 days a week
- Free shipping and supplies
If you or a member of your family takes a specialty drug, please call 1-800-803-2523 or visit www.shpnc.org/specialty-care.html
Whom should I call with questions regarding the prior authorization programs?
Please contact Medco member services at 1-800-336-5933.
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