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 chronic conditions. These medications typically require special storage and handling.

What is the Group Health specialty medication program?
Group Health has created a specialty medication program to work closely with patients to manage certain specialty medications. By having patients order directly through the program, we can work together to achieve a better outcome and get the most from their treatment.

Our specialty medication team of pharmacists and technicians will work closely with you and your doctor to:

  • Ensure that your medication is working for you.
  • Work with your doctor about any medication concerns we identify together.
  • Our team will reach out to you to set up refills for delivery to your specified location.
  • Remind you of needed labs and review the results with you.
  • Ensure medicine and supplies are readily available.

Our experienced specialty medication team is dedicated to your care. We understand your condition and medication needs:

  • Specially trained pharmacists are available from 8:30 a.m. to 5 p.m., Monday through Friday by calling toll-free, 1-800-483-3945. They will answer your questions about medications, potential drug interactions, side effects, and help identify new symptoms. They can also discuss your progress and coordinate with your doctor.
  • The Consulting Nurse Service is available 24/7 by calling toll-free, 1-800-297-6877. Nurses are able to consult your medical record, and a physician is always available.

What conditions are covered by the specialty medication program?

  • Certain forms of arthritis
  • Crohn's disease
  • Cystic fibrosis
  • Multiple sclerosis
  • Psoriasis

What medications are included in the specialty medication program?

  • Aubagio
  • Avonex
  • Betaseron
  • Copaxone
  • Enbrel
  • Extavia
  • Humira
  • Kalydeco
  • Rebif

What is the cost of the specialty medication program?
Group Health members using these medications are automatically enrolled in the specialty medication program. There is no cost to the patient.

What is changing?
Effective Dec. 1, 2012, if you are a patient taking any of these eight specialty medications (Enbrel, Humira, Copaxone, Rebif, Avonex, Extavia, Betaseron and Kalydeco), the locations where you can fill your prescriptions for these medications will change:

  • Non-Medicare members who do not have an out-of-network (OON) pharmacy benefit will only have coverage if they fill their prescription through the Group Health specialty medication program.
  • Non-Medicare members who choose to use their OON pharmacy benefit will experience a much higher cost share. The in-network benefit will only be available by using the pharmacies in the Group Health specialty medication program.

Why is this happening?
Specialty medications are expensive and usually require special monitoring and handling. Group Health has created a specialty medication program that will give you access to a specially trained pharmacist who will regularly check to see how your treatment is going, check on side effects, and answer any questions you might have. Group Health is able to obtain these medications at much lower cost, and it's important for us to be good stewards of all our members' premium dollars.

How are patients being notified about this change?
If you are currently taking any specialty medications covered by the Group Health specialty medication program (Enbrel, Humira, Copaxone, Rebif, Avonex, Extavia, Betaseron and Kalydeco) and using a contracted network retail pharmacy to fill the prescription, you should have received a letter informing you of the pharmacy network change, followed by a telephone call to set up a longer telephone consultation with a specially trained Group Health pharmacist.

Was my doctor (prescriber) notified about this change?
Yes, your doctor has been made aware of how and why Group Health is making this change.

Does Group Health honor patient assistance programs?
If you qualify for a manufacturer's patient assistance program, please let Group Health know. Some patient assistance programs are not supported by Group Health. If it is a program that cannot be billed by Group Health, the medication can be filled by our alternate in-network, mail-order pharmacy, Diplomat Specialty Pharmacy.

How do I get set up on the specialty medication program?
A specialty medication team member will contact you to set up a welcome call appointment with a pharmacist. You should expect this call to last about a half hour. Group Health will then contact your prescriber or pharmacy to transfer the prescription.

Does my doctor know how to work with the specialty medication program?
Yes. Your doctor has received detailed information about how to get patients set up in the program and how to submit prescriptions by fax or e-prescribing.

Can I get my other medications filled at Group Health and delivered too?
Yes! A specialty medication team member will help you order your other medications through the Group Health mail-order pharmacy. There is no charge for shipping anywhere in the United States, and you can even track your order online.

How do I order refills?
A specialty medication team member will call you 7 to 10 days before it is time for a refill. We'll ask about how the medication is working for you, how and when you take it, and then verify the preferred shipping address and the best contact information.

You may also contact Group Health specialty medication program toll-free at 1-800-483-3945 to set up delivery.

Where can I have my medication and supplies delivered?
Group Health will ship your medications at no additional cost to your home or any location you choose within the United States. You will also receive supplies to administer self-injectable medication, if needed.

How long will it take for my prescriptions to be delivered?
Specialty medications that require refrigeration will be delivered by UPS. Deliveries are made Tuesday through Friday. The specialty medication team member can estimate a delivery date during your reminder call. Package tracking is available online through MyGroupHealth. Other mail-order medications are usually delivered within three to five working days.

How many days' supply can I get at one time?
In most instances, specialty medications are refilled once a month.

Who do I talk to if I have questions?
Call the Group Health specialty medication program toll-free at 1-800-483-3945, Monday through Friday, 8:30 a.m. to 5 p.m.

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