Specialty Medications

As of July 1, 2009, there are important benefit changes for all specialty medications.

Many complex conditions are treated with specialty medications.  Specialty medications 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, hepatitis C, multiple sclerosis, asthma, growth hormone deficiency, rheumatoid arthritis and hemophilia. Medications classified by the Plan as specialty medications meet all of the following conditions:

  • Have unique uses for the treatment of complex diseases
  • Require special dosing or administration
  • Require special handling
  • Are typically prescribed by a specialist provider
  • Exceed $400 cost to the Plan per prescription

Pharmacy Benefit Changes for Specialty Medications

Beginning July 1, 2009, State Health Plan members must use Accredo for all non-acute specialty medications currently filled at retail pharmacies and covered under the pharmacy benefit.  If a member uses a pharmacy other than Accredo to purchase any of the non-acute specialty medications listed, they will be responsible for paying the total amount of the prescription at the time of purchase. 

  • Members may file a paper claim with Medco for reimbursement if the total amount is paid at a retail pharmacy.
  • Members will be responsible for any amount above the State Health Plan’s cost and the copay. 
  • Medications used to treat cancer are not affected by this change.

Also as of July 1, 2009, the copay for all specialty medications will require the member to pay 25% coinsurance up to $100, for each 30-day supply. 

Using Accredo

Accredo 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. 

The quality services of Accredo include:

    • Answers to your questions or concerns about your specialty medications from a pharmacist 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 extra charge
    • Refill reminder calls

It’s easy to get started using Accredo. You have the option of contacting Accredo directly, or you may prefer to have your provider contact them regarding your prescription.

OPTION 1 — Call Accredo specialty pharmacy:

Step 1:   Simply call Accredo specialty pharmacy toll-free at 1-800-501-7260 between                8:00 a.m. and 8:00 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 prescription drug                ID card), and ask him or her to call 1-800-987-4904. Your provider may also                order your specialty medication by accessing the Accredo Web site,                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 these specialty pharmacy benefit changes, view the Frequently Asked Questions. To learn more about Accredo specialty pharmacy services, call 1-800-803-2523 or visit the Accredo Web site.