Specialty Pharmacy Frequently Asked Questions
The following FAQs answer some common questions about specialty medications.
Accredo and Specialty Medications
Q: I received a letter from United Healthcare telling me I’m going to have to change the way I get my medication. What’s this all about?
A: The Empire Plan is implementing a new program called the Specialty Pharmacy Program in order to help enrollees taking specialty medications achieve the best possible outcomes from their treatments. By ensuring quality care, with improved clinical outcomes, the Program will also help control the rising cost of specialty medications.
Under this Program, most specialty medications will only be covered at the in-network (or highest) benefit level when dispensed by Accredo, the Empire Plan’s Designated Specialty Pharmacy. On or after April 1, 2010, only one fill of a prescription for a specialty medication dispensed by a pharmacy other than Accredo will be covered at the usual copayment amount. You must get subsequent refills of the specialty medication from Accredo to avoid significant out-of-pocket costs. If you use a pharmacy other than Accredo for your refills, you must pay the full cost of your specialty medication at the time of purchase and file a claim for reimbursement. You will not be reimbursed the total amount you paid for your medication and your out-of-pocket cost will be significantly higher than the mail-order copayment amount you would have paid if Accredo dispensed the medication.
Q: Can you tell me more about Accredo?
A: Accredo is a wholly-owned subsidiary of Medco and was founded over 20 years ago.
The Accredo patient care team – which includes pharmacists, nurses, and patient care representatives who are experienced in specialty medications – is available to assist with patient care management and care coordination. Services include disease and drug education, compliance management, side-effect management, and safety monitoring. Through Accredo, the Specialty Pharmacy Program provides:
· Toll-free access to specialty-trained pharmacists and nurses 24 hours a day, 7 days a week
· Expedited, scheduled delivery of your medications at no additional charge
· Necessary supplies, such as needles and syringes, provided with your medications
· Refill reminder calls so you remember to order your medications on time
What is the relationship between Medco and Accredo?
A: The New York State Health Insurance Program’s Empire Plan Prescription Drug Program is currently administered by United Healthcare (UHC). UHC uses the administrative and mail distribution services of Medco. Accredo is a wholly-owned subsidiary of Medco and will be the Designated Specialty Pharmacy for the Empire Plan Specialty Pharmacy Program. Accredo provides enhanced care and services to patients on medications used to treat complex diseases.
What are specialty medications?
A: Specialty medications are drugs that are used to treat complex conditions and illnesses such as cancer, growth hormone deficiency, hemophilia, hepatitis C, immune deficiency, multiple sclerosis, and rheumatoid arthritis. These drugs usually require special handling, special administration, and intensive patient monitoring. (Medications used to treat diabetes are not considered specialty medications.) Whether they are administered by a health care professional, self-injected, or taken by mouth, specialty medications require an enhanced level of service. For a listing of specialty medications currently included in the Program, visit the NYS Department of Civil Service website at http://www.cs.state.ny.us. On the Civil Service home page, select “Benefit Programs” and then follow the instructions to access NYSHIP Online.
Does the requirement to use Accredo apply to specialty medications that are
currently billed by my physician and paid for by United Healthcare under the
medical portion of The Empire Plan?
No. This change does not apply to specialty medications that are billed by your
physician and paid for by United Healthcare under the medical portion of The
Q: How does this Program benefit me?
A: The Specialty Pharmacy Drug Program is intended to increase the quality of care you receive. Accredo deals exclusively with providing medications to treat complex conditions. Accredo will:
· Contact you to ask you some questions to learn more about you and to plan for support services, such as nurses, that you may need while taking the specialty drug.
· Contact you before your refill date to see if there have been any changes in your therapy, process your refill order, and set up a specific date for delivery of your medication.
· Deliver your specialty drug at a time that is convenient for you. Delivery can be to your doctor’s office, a clinic, a treatment center, or to your home or other designated location.
· Provide necessary supplies such as needles and syringes with your medication(s) at no additional cost.
· Teach you and your caregiver how to use your specialty drug if you or a caregiver will be administering it.
· Arrange for nursing services if your doctor determines that the specialty drug must be administered by a nurse.
· Provide training and information about your specialty drug including how to properly handle and store your drug, possible side effects and how to manage these side effects, etc.
· Provide toll-free, telephone access to a patient call center operated by the specialty pharmacy provider that is available 24 hours a day, 7 days a week to answer any questions you may have about your specialty drug.
· Monitor for drug interactions and consult with your physician when necessary.
Orders and Delivery
What do I need to do to start using Accredo?
A: It’s easy to get started using Accredo. Choose one of the following two options to take the first step toward an uninterrupted, covered supply of the specialty medications you need.
OPTION 1 – Call The Empire Plan’s specialty pharmacy, Accredo:
Step 1: Call The Empire Plan Prescription Drug Program toll-free at 1-877-7NYSHIP (1-877-769-7447) and select option 4 between 8:00 a.m. and 8:00 p.m., Eastern Time, Monday through Friday, to access Accredo. You will be asked to provide your physician’s name and telephone number.
Step 2: Accredo will contact your physician to transfer your prescription to Accredo.
Step 3: Accredo will contact you to arrange for expedited delivery of your medication(s) at a time that is convenient for you.
OPTION 2 – Have your physician call The Empire Plan’s specialty pharmacy, Accredo:
Step 1: Provide your physician with your Empire Plan enrollee ID number and ask him or her to call Accredo’s toll-free physician line at 1-800-987-4904. Accredo will work with your physician to transfer your prescription to Accredo.
Step 2: Accredo will contact you to arrange for expedited delivery of your medication(s) at a time that is convenient for you.
Q: I already use Accredo to get my specialty drug(s). Do I need to do anything?
A: No. If you already receive your specialty drug services from Accredo you do not have to do anything.
Q: What if my specialty drug requires prior authorization?
A: The process for obtaining prior authorization will not change. Medco must approve drugs requiring prior authorization before Accredo can fill the prescription.
Q: How do I order a refill for my specialty medication?
A: Accredo will remind you each month to refill your specialty medication and to schedule a convenient time for delivery. These monthly calls give you a chance to ask questions, make sure you have the medication you need, and reinforce guidelines for care.
Q: How will my specialty drug(s) be delivered from Accredo?
A: Accredo will contact you to arrange for expedited delivery of your medication(s) at a time that is convenient for you. Your specialty drug(s) will be delivered to the place designated by you or your doctor and could include:
· Your doctor’s office, a clinic, or a treatment center
· Your home, work, or school
Q: If the specialty drug is being delivered to me either at home or another designated location, do I need to be available to receive it?
A: Accredo will advise you if your package will be sent in a manner that requires signature upon delivery. Prior to delivering the drug, the specialty pharmacy will contact you to make arrangements for delivery and confirm the location (home, work or school) and the date.
Q: How can I be sure my specialty medication will be safe to use when it arrives?
A: Accredo uses registered pharmacists specially trained in your therapy to fill all prescriptions. To protect your safety, Accredo’s pharmacists check for potentially harmful drug interactions and allergies for all the medications you are taking. If they have a question about one of your prescriptions, an Accredo pharmacist will contact your doctor prior to filling the order. Finally, a pharmacist reviews the entire order before shipping.
All medications are carefully packed so that they will arrive protected from breakage and at the proper temperature (using cold packs for medications that require refrigeration). Your medication should always arrive in a sealed package via expedited, scheduled delivery. If you suspect tampering or damage of any kind, you should call Accredo immediately.
Q: What if my delivery does not arrive or is damaged?
A: Accredo uses expedited, scheduled delivery so you can receive your medications quickly and safely. If you don't receive your order on schedule or it arrives damaged, contact the Accredo Specialty Pharmacy immediately. Call The Empire Plan Prescription Drug Program toll-free at 1-877-7NYSHIP (1-877-769-7447) and select option 4. Tell the customer service representative that your package did not arrive or is damaged, and they will assist you.
Q: What if, in an emergency, I need my specialty medication immediately?
A: If you need your specialty medication immediately, call The Empire Plan Prescription Drug Program toll-free at 1-877-7NYSHIP (1-877-769-7447) and select option 4. Tell the customer service representative that you need your medication on an emergency basis, and they will assist you.
Cost and Payment Options
Q: What will I have to pay for my specialty medication ordered through Accredo?
A: When you order a covered specialty medication through Accredo, your out-of-pocket cost will be limited to the applicable mail-order copayment. For up to a 30-day supply, the copay amount is $5 for a generic, $15 for a preferred brand name drug and $40 for a non-preferred brand name drug. For a 31-90 day supply, the copay amount is $5 for a generic, $20 for a preferred brand name drug and $65 for a non-preferred brand name drug. There are no additional costs for shipping and handling or for necessary supplies such as needles and syringes.
Q: How do I pay for my order?
A: Your payment options include check, money order, or credit card.
Q: Is the days supply limited to 30-days for my specialty medication?
A: No. When beginning therapy, physicians generally prescribe a 30-day supply of specialty medications. Once the physician has determined the medication is right for the patient, the prescription can be filled for a 90-day supply. There are a limited number of exceptions to this general practice due to clinical dispensing guidelines for those particular specialty medications.
Accredo Specialty-Trained Pharmacists and Nurses
Q: Will Accredo ever contact my doctor?
A: Yes, Accredo may need to contact your doctor to:
· Ask your physician clarifying questions about your prescription
· Discuss possible drug allergies or interactions with other medications you take
· Discuss how to manage your side effects
Q: What guidance can I expect from the Accredo specialty-trained nurses?
A: You will have a one-on-one relationship with a specialty-trained nurse who can help you manage your health condition, encourage you to take and/or administer your medication, and provide education, tips for managing side effects and a personalized plan of care. The guidance provided by the specialty-trained nurses isn’t meant to replace or interfere with the care you receive from your doctor – Accredo’s nurses are an additional resource to help you manage your treatment effectively. Based on your needs, they may also refer you to other Empire Plan programs (e.g., the Home Care Advocacy Program), when appropriate.