Members in the program need to use a participating specialty pharmacy for medications covered under their Pharmacy Benefit in order to receive their in-network benefits. Members new to therapy or switching from another insurance plan receive a letter and outbound telephone call directing them to a participating specialty pharmacy. For most therapeutic categories, members may use a grace fill at a retail pharmacy to start therapy in the interim as they transition to a participating specialty pharmacy. After speaking with a participating specialty pharmacy, members receive a welcome kit including additional educational resources and information. Members are then proactively contacted each month to set up their refills. They may also have the opportunity to take advantage of Clinical Management and/or Adherence Programs, depending on the medications they're taking.

The Specialty Pharmacy Program offers members access to nationally-contracted, expert specialty pharmacies. Just by calling their specialty pharmacy, members can:

• Fill medications covered under their Pharmacy Benefit
• Access clinical pharmacists 24 hours a day
• Get information on their medications or health and wellness topics related to their condition
• Enroll in Clinical Management and/or Adherence Programs for certain medications

UnitedHealthcare supports an Average Sales Price (ASP)-based physician fee schedule as a cost-efficient means to reimburse Medical Benefit medications and leave the sourcing through "buy and bill." This helps provide convenience for the physician and member, and potentially prevents drug waste. If "buy and bill"is not an option for certain medications, using one of UnitedHealthcare's contracted specialty pharmacies or directing your patient to use an infusion provider may be appropriate. The medications can be delivered to your office or clinic, or to your patients at an infusion center or through a home health care service. Learn more by visiting the medication index page and clicking on the specific medication.

Certain specialty medications may have:

• Drug policies (UnitedHealthcare's evidence-based proven criteria for clinical use)
• Administrative guide protocols (mandatory sourcing through participating specialty pharmacies)
• Supply limits (maximum days supply or quantity of medications that can be dispensed or billed at one time)
• Notifications (provider must submit clinical information about the patient in order for a prescription on the Pharmacy Benefit to be dispensed)

To find out if a medication has any associated sourcing guidelines, visit the medication index page, and click on the specific medication.

To learn more about reimbursement for specialty medications, visit UHCOnline.com.