Group Health Specialty Medication Program FAQs

What is a specialty medication?
A specialty medication is a high-cost drug that requires close supervision and monitoring for serious and/or complex chronic conditions. These medications often require special storage, handling, or dosing procedures.

What is the specialty medication program?
The Group Health specialty medication program (SMP) works closely with patients and medical providers to manage certain specialty medications in order to achieve better health outcomes and get the most benefit from their treatment.

The centerpiece of SMP is a team of specially trained pharmacists and technicians that regularly reviews each patient's medication, side effects, and other issues before ordering the next refill. This relationship gives the patient a regular opportunity to ask questions and discuss any difficulties with the medication. It also provides a regular reminder of any needed labs or clinical monitoring to assure safety for the patient. The SMP staff will place the refill order following a telephone consultation with the patient.

SMP staff are available 8 a.m. to 6 p.m., Monday through Friday (except for major holidays), toll-free at 1-800-483-3945. They will answer your questions about medication, potential drug interactions, side effects, and help identify new symptoms. They can also discuss your progress and coordinate with your doctor.

When SMP is not open, the Group Health Consulting Nurse Service is available 24/7, toll-free at 1-800-297-6877. Consulting nurses can review your medical record, and a physician is always available.

What medications are included in the Specialty Medication Program?
List of specialty medications

What is the cost to patients?
Group Health members using these medications will be offered enrollment in the Group Health specialty medication program. There is no added cost to the patient.

Will SMP be able to work with patient assistance programs?
SMP staff understand that specialty medications can present a difficult financial challenge for patients. They can help you take advantage of applicable assistance programs for high-cost medications.

Does my doctor know how to work with SMP?
Yes. We work closely with your doctor to ensure we provide you with the best care and service. Your doctor may contact our team anytime during hours of operation and send us prescriptions by fax, phone, or electronic prescriptions.

How do I get refills?
An SMP team member will contact you about seven days before it is time for a refill. We'll ask how the medication is working for you, how and when you take it, if there are any changes in your lifestyle or diet, and verify the preferred shipping address and the best contact information. You can contact SMP toll-free at 1-800-483-3945, to set up delivery.

Where can I have my medication delivered?
Group Health will ship your medications at no additional cost to your home or another specified location.

How long will it take for my prescriptions to be delivered?
Specialty medications that require refrigeration will be delivered by UPS. Refrigerated item deliveries are scheduled to arrive Tuesday through Friday. An SMP team member can coordinate an appropriate delivery date during your reminder call.

How many days' supply can I get in each refill?
Most specialty medications are refilled once a month, based on your benefits plan.

How can I pay the cost share for my prescriptions?
We require the patient's cost share be paid in advance using a Visa, MasterCard, Discover, or American Express credit or debit card. This includes most pre-paid debit cards that can be purchased from retail stores or banks. SMP is not able to accept checks, except by special arrangement.

Who do I talk to if I have questions?
Call the specialty medication program toll-free at 1-800-483-3945. SMP is open 8 a.m. to 6 p.m., Monday through Friday (except for major holidays).

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