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Specialty drugs

What is a specialty drug?

Specialty drugs are biologics or prescription drugs that require special handling, provider coordination and patient education for safe and effective use. They can only be dispensed for up to a 30 day supply at a time.

For the most current listing of specialty drugs, refer to the covered drug list. Specialty drugs are designated with 'SP' on your formulary.

These drugs are only available to members through Pharmacy Advantage, a specialty pharmacy service that mails them to your home. You must sign up for Pharmacy Advantage to get specialty drugs. These drugs require prior authorization, meaning your doctor must request permission for them to be covered by your plan.

Conditions that may require treatment with specialty medications include:

  • Crohn's disease
  • Hemophilia
  • Hepatitis B
  • Hepatitis C
  • Infertility
  • Immune disorders, such as Guillain-Barré syndrome or lupus
  • Kawasaki disease
  • Multiple sclerosis
  • Plaque psoriasis
  • Rheumatoid arthritis
  • RSV (prevention)

Our Specialty Pharmacy Program focuses on medication safety. We want to make sure you receive safe, cost-effective medications and that you know how to take them correctly.

How do I order specialty drugs?

Our goal is to make sure you have access to the specialty drugs you need. We partner with Pharmacy Advantage to provide medications that are not readily available at retail pharmacies.

Pharmacy Advantage can help you and your doctor submit a prior authorization request by calling (800) 456-2112.

Pharmacy Advantage can deliver medication to your home, or you can pick it up at one of its 19 locations in southeast Michigan. Call Pharmacy Advantage at (800) 456-2112 to find a specialty pharmacy near you, or have your doctor fax your prescription to (888) 400-0109.

Pharmacy Advantage services

Take advantage of these specialty drugs benefits through our Pharmacy Advantage partnership:

  • Direct outreach for counseling and educational materials
  • Support services to help you successfully use your specialty medication
  • Refill reminder service to help manage your medication schedule
  • Nursing and social support in collaboration with your doctor
  • Free supplies as needed for your prescribed disease management programs (e.g., syringes)
  • Prescription coverage verification completed for you