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Common Specialty Medications

 
Common Specialty Medications are self-administered specialty injectable drugs through the CVS Specialty Pharmacy. Through the CVS Specialty Pharmacy, you will be assigned a dedicated CareTeam with specialists in your condition. These specialists will check in to see what you need and how they can help moving forward.  They'll also make arrangements for injection training, as needed. If your physician prescribes a common specialty drug, they can call 1-800-237-2767, fax 1-800-323-2445, or e-prescribe the specialty drug to the CVS Specialty Pharmacy. CVS Specialty will then work with your doctor to obtain prior authorization for the specialty medication. Once approved, you can have your specialty medications delivered directly to you.

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.  Only your actual out-of-pocket payments will count toward your drug deductible and annual out-of-pocket maximum; not amounts discounted off the price by the manufacturer or seller of the specialty medication. 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 generally 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; however, certain specialty medications are subject to variable copayments, depending on the availability of programs.  Only your actual out-of-pocket payments will count toward your drug deductible and annual out-of-pocket maximum, not amounts discounted off the price by the manufacturer or seller of the specialty medications.  Contact CVS Caremark to verify copayments.  These drugs are not available in 90-day supplies.  If you are prescribed one of these common specialty medications, call CVS Caremark at 1-844-260-5894.


Common Specialty Medications