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. Certain self-administered specialty medications are excluded from the State Health Plan's medical benefit, but are covered under the prescription drug benefit.
To determine whether a self-administered specialty drug is only covered as a prescription drug benefit, please review the Specialty Drug List. This list is subject to change due to new self-administered medications becoming available. These new medications will be added to this list as quickly as possible and excluded from the medical benefit.
Conditions commonly requiring specialty medications include:
- Anemia
- Asthma
- Growth Hormone Deficiency
- Hemophilia
- Hepatitis C
- Multiple Sclerosis
- Rheumatoid Arthritis
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
Using 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.
State Health Plan members must use Accredo for all non-acute specialty medications filled under the pharmacy benefit. If a member uses a pharmacy other than Accredo to purchase any of the specialty medications listed, they will be responsible for paying the total amount of the prescription at the time of purchase.
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 the specialty pharmacy benefit, view the Frequently Asked Questions. To learn more about Accredo specialty pharmacy services, call 877-988-0059 or visit the Accredo website.
