Changes for Specialty Pharmacy Drug Refills

  • October 17, 2019

    Starting January 1, 2020, members with the mandatory specialty benefit will be required to fill specialty drugs at an in-network Specialty Pharmacy. The Specialty Pharmacy Program will no longer include two fills at in-network retail pharmacies for members with the mandatory benefit.

    Currently members with the mandatory specialty benefit may get up to two specialty drug fills at any in-network retail pharmacy before needing to use a preferred specialty pharmacy. After January 1, as members’ groups renew, specialty drugs must initially be filled at a preferred specialty pharmacy or the fills will reject at the point of sale. A message will display with contact information for the specialty pharmacy and/or Premera Customer Service to ensure the member is directed to the appropriate pharmacy.

    Premera offers two different specialty pharmacy networks:

    1. Exclusive Specialty: For customers with the Exclusive Specialty Pharmacy Network, the Specialty Pharmacy is Accredo.
    2. Dual Specialty: For customers with the Dual Specialty Pharmacy Network, the specialty pharmacies are Accredo and AllianceRx Walgreens Prime specialty pharmacy
      * To identify what pharmacy(s) your patient can use, call the Provider Services Line at 800-722-1471.

    See the Mandatory Specialty List for a detailed list of drugs

    Providers have the option of obtaining office-administered specialty drugs from our preferred specialty pharmacies. Specialty pharmacies help reduce the administrative burden and the need to keep office inventory of injected specialty drugs.

    Premera is committed to finding solutions that address rising pharmacy costs while still providing quality care and a great customer experience. If you have questions about this change, call Physician and Provider Relations at 877-342-5258, option 4.

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