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Common Specialty Medications


All specialty medications require Precertification. The process begins with a call to HealthSmart Specialty Drug Program at 1-888-440-7342. HealthSmart will review the drug for medical necessity, and if approved, will coordinate the purchase through an approved source. Many specialty medications have manufacturer programs which will financially assist patients in the purchase of the medication. PEIA requires that if a financial assistance program is available, you must participate in the program. Specialty drugs have the following key characteristics:

  • Need frequent dosage adjustments
  • Cause more severe side effects than traditional drugs
  • Need special storage, handling and/or administration
  • Have a narrow therapeutic range
  • Require periodic laboratory or diagnostic testing
After you have met your prescription drug deductible, the copayment on these medications will be $100 for any Common Specialty Medications on the WV Preferred Drug List and $150 for any Common Specialty Medications not on the WV Preferred Drug List. Only your actual out-of-pocket payments will count toward your drug deductible and annual out-of-pocket maximum. Amounts discounted off the price by the manufacturer or seller of the specialty medication do not count. These drugs are not available in 90- day supplies. If you are prescribed one of these common specialty medications, call HealthSmart at 1-888-440-7342.
If you are prescribed one of these common specialty medications, call HealthSmart toll-free at 1-888-440-7342.

Common Specialty Medications