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What is the Specialty Pharmacy Program? |
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UnitedHealthcare realizes that although specialty medications are costly and can be challenging to manage, they can also deliver improvements in overall medical outcomes for our members. Because of this, we've implemented a Specialty Pharmacy Program. This program is designed to support your treatment plan for their condition and facilitate the physician and patient relationship. At the same time, it can help members effectively manage rare or complex diseases and make the most of their benefits by giving them access to the right specialty medications, programs and support — so they can achieve the right results. We take an integrated approach that includes consistent management across Medical and Pharmacy Benefits, and integrates care coordination by aligning support programs, data and clinical resources available to our members.
Pharmacy Benefit
Using our size and market presence, we’ve established a select specialty pharmacy network that provides members and health care professionals convenient access to specialty medications, significant discounts and comprehensive services, including:
- Condition and medication education
- Specially trained pharmacists available 24 hours a day
- Medication-related supplies at no additional cost
- Clinical management and support services
- Refill reminders and timely delivery
- Coaching on lower-cost options
Members taking certain medications are able to take part in Clinical Management Programs provided by the specialty pharmacies. While enrolled in these programs, members work one-to-one with a specialized nurse or pharmacist who provides support, education and resources that can lead to better outcomes. Clinical Management and Adherence Programs for a specific medication can be found by visiting the medication index page and clicking on the medication. Medical Benefit
Specialty medications are often the highest cost of your patient's therapy. As a health care professional, the choice of medication and your source for procurement can also have a significant influence on your patient's out-of-pocket costs. UnitedHealthcare supports an Average Sales Price (ASP)-based physician fee schedule as a cost-efficient means to reimburse Medical Benefit medications and therefore allow physicians to dispense and bill most medications. 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 the member to use an infusion provider may be appropriate. Through established national contracts, we're able to offer competitive pricing which often leads to lower costs for members. Sourcing channel options can be found by visiting the medication index page and clicking on the specific medication.
Medication Guidelines
We make use of evidence-based drug policies, administrative guide protocols, supply limits and notifications criteria to control waste, keep costs down and support clinically appropriate drug use. Guidelines specific to each medication can be found by visiting the medication index page and clicking on the specific medication. |
