Specialty Pharmacy Management

PrecisionRx Specialty Solutions is a full-service specialty pharmacy created to more effectively manage and monitor the distribution of specialty medications.

PrecisionRx Specialty Solutions offers a robust support program including a team of personal care coordinators, pharmacists and nurses to help customers taking specialty medications achieve the best possible outcomes from their treatments.

What are specialty drugs?

Specialty drugs consist of high-cost oral, injectable and infused medications that are used to treat and manage complex diseases such as multiple sclerosis, cancer, hepatitis C and certain forms of rheumatoid arthritis.

Specialty drugs are complex in both design and administration and often require special handling such as temperature-controlled packaging and overnight delivery.

What health conditions are considered part of specialty pharmacy?

Many conditions are coordinated through our specialty pharmacy. The PrecisionRx Specialty Solutions program offers medications and disease-specific personal care coordination to help promote quality, safety and clinical effectiveness for many key therapeutic categories including, but not limited to:

Asthma

Cancer

Gaucher

Growth Hormone

Hemophilia/Bleeding Disorder

Hepatitis C

HIV/AIDS

Infertility

Primary Immune Deficiency

Psoriasis

Pulmonary Arterial Hypertension

Rheumatoid Arthritis

Multiple Sclerosis

Respiratory Syncytial Virus (RSV)

Transplant

What drugs are included in “specialty medications?”

For the most recent list of specialty medications, list of specialty medications. The inclusion of a medication on the Internet listings is not a guarantee of availability or benefits. For verification of a medication, please contact PrecisionRx Specialty Solutions at 1-800-870-6419.

How do customers benefit by using PrecisionRx Specialty Solutions over a local pharmacy?

PrecisionRx Specialty Solutions involves the prescribing physician, pharmacist and customer to help more effectively manage specialty medications and conditions. Benefits include:

One-on-one service and support from a personal care coordinator. Educated on the customer’s medication and ancillary needs, the personal care coordinator will assist the customer throughout care.

Making sure customers understand what to expect from treatment, drug interactions or side effects so they are more engaged in their treatment.

To help more effectively manage the customer’s medication and condition, PrecisionRx Specialty Solutions works closely with the customer (patient) to help coordinate patient-physician follow-up.

Administration supplies like needles, syringes, etc. with many medications at no
additional cost.

Proactive calls designed to schedule timely refills, educate and monitor drug regimens and encourage therapy adherence.

A team of billing experts to help with payment or reimbursement issues.

Access to medication assistance programs that help ensure certain vital medications are available to those individuals in need.

What Medical Assistance Programs are available for the uninsured or underinsured?

Medication Assistance Programs assist uninsured or under-insured individuals in securing life-saving or life-sustaining medications.

Will PrecisionRx Specialty Solutions help control the costs of specialty drugs?

PrecisionRx Specialty Solutions is confident that better coordination of specialty pharmacy activities will result in increased satisfaction, the opportunity for improved clinical outcomes for people taking specialty medications, and in helping to control the costs of specialty drugs. For example:

By developing a baseline clinical picture of people with hepatitis C and tracking the progress of treatment, thousand of dollars in savings per person may result from discontinuation of therapy* for those who do not respond to treatment after 12-16 weeks of therapy.¹

The average cost of a Multiple Sclerosis (MS) exacerbation, an increase in the severity of the disease or its signs and symptoms, can reach several thousand dollars. PrecisionRx Specialty Solutions MS care management program results in fewer exacerbations, as compared to the national average rate of 1.0 exacerbations in MS patients. Significant costs associated with exacerbations could be averted when exacerbations in MS are reduced by therapy management, according to PrecisionRx Specialty Solutions Quarterly Clinical Management Year End Report, 2005.

Another way PrecisionRx Specialty Solutions is helping to control costs is through Assay Management, making sure specialty drugs are more appropriately dispensed. For example, dispensing hemophilia product assays as close to the prescribed dose as possible can save considerable dollars. An industry standard is to dispense within ±10% of the prescribed dose. PrecisionRx Specialty Solutions goal is to dispense a prescribed dose within a lower allowable percentage, resulting in greater savings.

Backed by the strength and security of one of the nation’s leading health benefits company, PrecisionRx Specialty Solutions also helps reduce escalating specialty drug costs by leveraging its entire national drug spend to access some of the best-in-industry manufacturer pricing.

Can specialty medications be ordered online?

Pharmacy law states that a prescription must be transmitted verbally or via fax directly sent from the physician or physician’s agent to the pharmacy.

How can customers be sure that their refill will get to them in a timely manner so they do not miss a dose?

PrecisionRx Specialty Solutions organizes and processes all orders based on the date the customer needs the specialty medication(s). The date medication is needed should be included in the initial request.

Medications are shipped directly to the physician’s office or to the patient’s homes, depending on the physician’s request.

What happens if specialty drugs are lost in shipment or delayed?

Any delay in shipment is communicated to the physician or customer as soon as it is identified. At that time, a new “need by” date is set between the personal care coordinator and the physician or customer and the order is processed based on the new date and expedited with highest priority.

Orders are shipped via UPS. Tracking numbers are used by UPS to identify and trace every package as it moves through the UPS system to its destination.

How can customers be sure their specialty medication will be safe when it arrives?

Because medications are shipped in unmarked packages, the likelihood that a package would be disturbed during delivery is remote. However, as a safeguard, tamper-evident packaging is used so it will be immediately evident to the recipient if the package was opened en route.

Medications that are sensitive to heat, cold or other environmental conditions are shipped in temperature-moderating/maintaining containers to protect the medication during shipping.

How can customers talk to a pharmacist or clinician if they have questions about their specialty medication?

Call PrecisionRx Specialty Solutions at 1-800-870-6419, Monday–Friday, 8 a.m.–midnight, Eastern Time; Saturday, 10 a.m.–6:30 p.m., Eastern Time. For speech and hearing impaired assistance (TDD/TTY), please call 1-800-221-6915, Monday through Friday, 8:30 a.m. to 5 p.m., Eastern Time.

PrecisionRx Specialty Solutions offers a robust support program with access to a team of personal care coordinators, pharmacists and nurses to help customers taking specialty drugs achieve the best possible outcomes from their treatments.

Will PrecisionRx Specialty Solutions fill all prescriptions?

PrecisionRx Specialty Solutions focuses only on people taking specialty medications and helping them achieve the best possible outcomes from their treatments. If PrecisionRx Specialty Solutions does not have access to a certain specialty medication, PrecisionRx Specialty Solutions will contact and transfer the prescription to the appropriate pharmacy that can fill the prescription.

Non-specialty medications should be filled through traditional local or mail service pharmacies. Visit your health plan’s website for instructions for mail order, as well as a complete and current list of participating pharmacies.

How do customers get started using PrecisionRx Specialty Solutions?

Ordering specialty medications through PrecisionRx Specialty Solutions is quick, easy and convenient, and one easy phone call will get you started. Call 1-800-870-6419 to verify patient and provider information. Personal care coordinators are available to take calls Monday–Friday, 8 a.m.–midnight, Eastern Time; Saturday, 10 a.m.–6:30 p.m., Eastern Time.

If you prefer to coordinate the conversion to PrecisionRx Specialty Solutions with your doctor, just have your doctor fax your prescription(s) and a copy of your insurance card to 1-800-824-2642.

¹ 2005 PRxSS Quarterly Clinical management Year End Report