How is a specialty medication different than other medications?
Specialty medications are typically for serious, and sometimes rare, health conditions. These therapies are usually very complex and are often more expensive. They may require special handling, could be more complicated to take, or might have serious side effects, causing patients that take these medicines to need more support.
Where is a prescription for a specialty medication sent?
For specialty medications, the doctor typically sends the prescription directly to the specialty pharmacy.
What happens first after my prescription is received by the specialty pharmacy?
After US Bioservices receives your prescription, we give you a phone call to welcome you to our pharmacy and let you know that we are working on filling your prescription. We also let your doctor know that we have received the prescription, and we get any follow-up details that might be needed. We immediately begin determining your insurance coverage for the prescription to help you start therapy as quickly as possible.
How do I know if my specialty medication is covered?
US Bioservices will check with your insurance to see if the medication that your doctor prescribed is covered by your plan. For specialty medications, insurance companies often require an additional approval called a prior authorization. This means the insurance company has to approve of the patient taking the medicine, before they will cover the costs.
What is a prior authorization?
Specialty medications are often very expensive, so an insurance company may want to verify the medical need for the prescription in advance. This is called a prior authorization. The prior authorization process involves submitting detailed clinical information and the history of therapies that the patient has already tried to the insurance company. The specialty pharmacy often helps the patient and the doctor's office with this process. The insurance company reviews this information and can ask for more information before making a decision, or can approve or deny covering the medicine.
How long does a prior authorization take?
The amount of time can vary, depending on the insurance plan. Some approvals happen within 24 hours and others can take weeks. We provide frequent updates to our patients and the prescribing physician during this process. US Bioservices understands the various authorization requirements for different plans and therapies, and we provide assistance to help the process move as quickly as possible. We frequently and proactively contact the insurance company to see if there are any updates until the authorization review is complete.
What happens if my prior authorization is denied?
If a prior authorization is denied, the patient and prescribing physician have the option to appeal the decision. If an appeal is sought, US Bioservices can help. Appeals often involve additional documentation that we can assist in submitting. We keep the lines of communication open, seeking regular updates from the insurance company, and providing frequent updates to the patient and the prescribing physician's office about the latest status.
What if my medication is covered but I still can’t afford my copay?
Even with approved insurance coverage, patients may have copays that are unaffordable. US Bioservices helps patients search for additional funding that may be available through the drug manufacturer or charitable foundations that assist with medical expenses. US Bioservices can help patients with the application process to determine if they are eligible for additional funding. We explore all funding options to help the patient have the lowest out-of-pocket cost for their medicine. In 2016, we secured $19 million dollars in assistance for our patients.
How do I get my medication from the pharmacy?
Most patients prefer to have their medications shipped directly to their homes. Our care coordinator will give you a call to make sure that we have all of the shipping details. For some specialty medications, a doctor or nurse must give you the medication. In these cases, our pharmacy can coordinate the shipment of your medicine to your physician's office or to another location to coincide with an appointment or surgery. For infused medicines, US Bioservices offers a team of nurses that provide clinically supervised infusions in the convenience of the patient’s home.
Why can only certain pharmacies fill my specialty prescription?
Drug manufacturers and insurance companies can both affect the pharmacies that can fill a prescription for a specialty medication.
The manufacturer may limit the pharmacies that can purchase the drug. This is called a limited distribution pharmacy network. These networks can include a group of pharmacies or they can be restricted to an exclusive network with only one pharmacy. One reason manufacturers do this is to ensure a certain level of patient care and clinical monitoring for complex medications.
Insurance companies may also limit the pharmacies where their members can receive specialty medications. The goal is to minimize waste and reduce costs by making sure patients are getting the right therapies and doses for their conditions.
A patient or doctor may not always know which pharmacy can fill a specialty prescription, but US Bioservices can help. We have access to many of the specialty medications with limited networks, and we understand the different options available with insurance companies. We work on a case-by-case basis with each patient, helping patients receive their medications as quickly as possible.
I’ve received my medication, but I have some questions. What should I do?
Specialty medications are often more complex, and we help our patients have the information and support they need to take the right medication dose, on time. Please call our pharmacy any time you have questions or concerns. Our team of pharmacists and nurses are available to help 24 hours a day, 7 days a week.
My medication has a REMS. What does that mean?
REMS are special requirements that the FDA has for medicines that have more risks associated with their use. As a patient, this means that before you can take the medicine, you might have to speak to a nurse or pharmacist, or you may need to have labs or other tests performed. You might need to read certain materials that explain the risks. REMS requirements vary by medicine. US Bioservices can help you understand the steps involved with your medicine, and our pharmacists are always available to answer your questions.
How do I dispose of unused, unwanted, or expired medication?
It is important to correctly dispose of your expired, unwanted or unused medications. For information regarding safe medication disposal, speak with your doctor, our pharmacy, or follow these guidelines found on FDA.gov.