MA Clients Impacted by the Specialty Pharmacy Drug Program
This program applies to MA clients:
- Whose pharmacy services are covered under the Fee-for-Service (FFS) delivery system, and
- Who use the MA Program ACCESS card to get their pharmacy services, and
- Who reside in the 42-county area of Pennsylvania shown on the map below in white.
This program does not apply to the following MA clients:
- Who are enrolled in a physical health managed care organization; or
- Whose specialty medications are covered by Medicare Part B or Part D or by a private health plan policy UNLESS those programs/policies/plans do not cover the specialty drug and the drug is covered by the Pennsylvania Medical Assistance Program. In that case, this program does apply.
Benefits of Specialty Pharmacy Drug Program
The Specialty Pharmacy Drug Program is intended to increase the quality of care you receive.
The specialty pharmacy providers 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 about 10 days prior to your refill date to see if there have been any changes in your therapy and set up a specific date for delivery.
- Deliver your specialty drug. This can be the doctor’s office, a clinic, a treatment center, or your home or other designated location.
- Teach you and your caretaker how to use your specialty drug if your or a caregiver will be administering.
- 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 handle side effects, etc.
- Provide a toll-free, patient call center run by the specialty pharmacy provider that is available 24 hours a day, 7 days a week to answer any medical questions you may have about your specialty drug.
- Monitor for drug interactions.
Additional benefits include:
- No co-payments for specialty drugs
- Free shipping
- Free administering supplies
- You can continue to get all non-specialty drugs at the pharmacy you usually use
Frequently Asked Questions for MA Clients
Do I have a choice of specialty pharmacy providers?
- Yes. You will need to choose between the two specialty pharmacy providers, Accredo or Medmark, A Walgreens Specialty Pharmacy. Then your doctor will have to contact the specialty pharmacy to order your prescription.
How long will it take for my specialty drug(s) to be delivered?
- Initially, when your doctor orders the specialty drug from one of the preferred specialty pharmacy providers, the drug will be delivered in time for the administration.
- About 10 days prior to your refill date, your specialty provider will contact you to verify if there have been any changes in therapy and to set up a specific date for delivery for your specialty drug.
What if I need my drug on the same day it is ordered?
- In the event that you have an immediate need for a specialty drug, the specialty pharmacy provider will work with you and your doctor to try and deliver your medication within 24 hours.
I currently have a home health nurse come to administer my drug. Do I need to change nurses?
- No. You may still use the same nursing service that you have been using. When your specialty pharmacy calls to arrange for the delivery of your specialty drug, make sure that you tell the specialty provider that you want to use the same nursing service that you currently use.
- Give the specialty pharmacy the name and contact information for your home health provider. The specialty pharmacy will coordinate delivery of the specialty drug with the nursing services you need to administer the drug.
Sample Client Notices
English Version - Specialty Pharmacy Drug Program
Versión en Español - Programa de Especialidades Farmacéuticas