|
Specialty Medications
Specialty medications are typically bio-engineered drugs that
have specific shipping and handling requirements or are required by
the manufacturer to be dispensed by a specific facility. PEHP has
partnered with Accredo Health Group, a division of Medco Health, to
assist us in dispensing specialty drugs for our members. Receiving
your specialty drug from Accredo will allow you to receive your
specialty medication at a lower cost (Benefit design may differ from
plan to plan. Please refer to your benefit summary for you actual
specialty benefit.) Also, PEHP may require that select specialty
medications be obtained from Accredo in order to be covered.
Accredo will coordinate with a member or physician to provide
delivery to either a member's home or physician's office. Free medical
supplies such as syringes and sharp containers are also available for
those medications that require them.
Specialty medications can require pre-authorization. Please
check the Pre-authorization Information or call PEHP Customer
Service at (801) 366-7555 to see if your medication requires prior
authorization.
It is easy to get started using Accredo. You can choose one of
the following options to help ensure an uninterrupted, covered supply
of the specialty medications that you may need:
| Step 1: |
Determine if your medication requires prior
authorization. If the medication requires prior authorization,
please contact your doctor so that he or she can obtain one. (Refer
to the Pre-authorization section for details.) |
| Step 2: |
If required, once your pre-authorization
is approved, call Accredo at
1-800-501-7260 between 8:00 a.m. and 8:00 p.m.,
Eastern Time, Monday through
Friday. |
| Step 3: |
Accredo will contact your doctor and make all the
arrangements needed to help ensure a smooth transaction so you can
recieve the medications you need. |
| Step 4: |
Accredo will call you back to arrange for expedited
delivery of your medications at a time that is convenient for you. |
| |
| Step 1: |
Provide your doctor with your member ID number (shown on
your prescription drug ID card) and ask him or her to call
1-800-987-4904. Accredo will work with your doctor to make the
transition smooth for you. |
| Step 2: |
Accredo will call you or your physician back to arrange for
expedited delivery of your medication. |
Refer to the table below on where to obtain your specialty medication for coverage. You may be required to obtain it through our specialty vendor. If your specialty medication is available through our specialty pharmacy and through a retail pharmacy and/or a provider's office, your benefit may allow you to receive your specialty medication at a lower copayment if you purchase your prescription though our specialty vendor.
* Requires Pre-authorization.
| Drug name |
Specialty pharmacy |
Retail pharmacy |
Physician's office |
| A.P.L |
Covered |
Not Covered |
Not Covered |
| Abraxane* |
Covered |
Not Covered |
Covered |
| Actimmune* |
Covered |
Not Covered |
Covered |
| Adagen* |
Covered |
Not Covered |
Covered |
| Advate |
Covered |
Not Covered |
Not Covered |
| Afinitor* |
Covered |
Not Covered |
Not Covered |
| Aldurazyme* |
Covered |
Not Covered |
Not Covered |
| Alferon-N* |
Covered |
Not Covered |
Not Covered |
| Alphanate |
Covered |
Not Covered |
Not Covered |
| Alphanate SD |
Covered |
Not Covered |
Not Covered |
| Amevive* |
Covered |
Not Covered |
Not Covered |
| Anzemet Inj.* |
Not Covered |
Covered |
Covered |
| Apokyn* |
Covered |
Not Covered |
Not Covered |
| Aralast* |
Covered |
Not Covered |
Covered |
| Aranesp* |
Covered |
Covered |
Covered |
| Arcalyst* |
Covered |
Not Covered |
Not Covered |
| Arixtra |
Covered |
Covered |
Not Covered |
| Arranon* |
Covered |
Not Covered |
Covered |
| Avastin* |
Covered |
Not Covered |
Covered |
| Avonex* |
Covered |
Not Covered |
Not Covered |
| Baygam |
Not Covered |
Not Covered |
Covered |
| Bayrho-D |
Not Covered |
Not Covered |
Covered |
| Bebulin |
Covered |
Not Covered |
Not Covered |
| Benefix |
Covered |
Not Covered |
Not Covered |
| Betaseron* |
Covered |
Not Covered |
Not Covered |
| Bicillin |
Not Covered |
Covered |
Covered |
| Bravelle |
Covered |
Not Covered |
Not Covered |
| Brovana |
Not Covered |
Covered |
Covered |
| Carimune* |
Covered |
Not Covered |
Not Covered |
| Cerezyme* |
Covered |
Not Covered |
Not Covered |
| Cetrotide |
Covered |
Not Covered |
Not Covered |
| Cimzia* |
Covered |
Not Covered |
Not Covered |
| Copaxone* |
Covered |
Not Covered |
Not Covered |
| Copegus* |
Covered |
Not Covered |
Not Covered |
| Cytogam* |
Covered |
Not Covered |
Covered |
| Cytovene |
Covered |
Not Covered |
Covered |
| D.H.E.* |
Not Covered |
Covered |
Covered |
| Dacogen* |
Covered |
Not Covered |
Not Covered |
| Degarelix* |
Covered |
Not Covered |
Covered |
| Demerol PCA |
Not Covered |
Covered |
Covered |
| Elaprase* |
Covered |
Not Covered |
Not Covered |
| Enbrel* |
Covered |
Not Covered |
Not Covered |
| Epogen* |
Covered |
Covered |
Covered |
| Epoprostenol* |
Covered |
Not Covered |
Not Covered |
| Erbitux* |
Covered |
Not Covered |
Covered |
| Euflexxa |
Covered |
Not Covered |
Covered |
| Exjade |
Covered |
Not Covered |
Not Covered |
| Fabrazyme* |
Covered |
Not Covered |
Covered |
| Feiba |
Covered |
Not Covered |
Covered |
| Flebogamma* |
Covered |
Not Covered |
Covered |
| Flolan* |
Covered |
Not Covered |
Not Covered |
| Follistim |
Covered |
Not Covered |
Not Covered |
| Forteo* |
Covered |
Not Covered |
Not Covered |
| Fragmin |
Covered |
Covered |
Covered |
| Fuzeon* |
Covered |
Not Covered |
Not Covered |
| Gamastan S/D* |
Covered |
Not Covered |
Not Covered |
| Gamimune* |
Covered |
Not Covered |
Not Covered |
| Gammagard* |
Covered |
Not Covered |
Not Covered |
| Gammar IV* |
Covered |
Not Covered |
Not Covered |
| Gamunex* |
Covered |
Not Covered |
Not Covered |
| Genotropin* |
Covered |
Not Covered |
Not Covered |
| Geref |
Not Covered |
Not Covered |
Covered |
| Gleevec* |
Covered |
Not Covered |
Not Covered |
| Granisetron Inj |
Not Covered |
Covered |
Covered |
| Helixate |
Covered |
Not Covered |
Not Covered |
| Hemofil M |
Covered |
Not Covered |
Not Covered |
| Hepagam B |
Not Covered |
Not Covered |
Covered |
| Herceptin* |
Covered |
Not Covered |
Covered |
| Humate-P |
Covered |
Not Covered |
Not Covered |
| Humatrope* |
Covered |
Not Covered |
Not Covered |
| Humira* |
Covered |
Not Covered |
Not Covered |
| Hyalgan |
Covered |
Not Covered |
Covered |
| Hyate |
Covered |
Not Covered |
Not Covered |
| Hycamptin IV* |
Not Covered |
Not Covered |
Covered |
| Immune Globulin IV* |
Covered |
Not Covered |
Not Covered |
| Increlex (Under age 22)* |
Covered |
Not Covered |
Not Covered |
| Infergen* |
Covered |
Not Covered |
Not Covered |
| Innohep |
Covered |
Covered |
Not Covered |
| Intron-A* |
Covered |
Not Covered |
Covered |
| Iplex* |
Not Covered |
Not Covered |
Covered |
| Iressa* |
Covered |
Not Covered |
Not Covered |
| Iveegam* |
Covered |
Not Covered |
Not Covered |
| Ixempra* |
Covered |
Not Covered |
Covered |
| Kineret* |
Covered |
Not Covered |
Not Covered |
| Koate |
Covered |
Not Covered |
Not Covered |
| Kogenate |
Covered |
Not Covered |
Not Covered |
| Konyne |
Covered |
Not Covered |
Not Covered |
| Kuvan* |
Covered |
Not Covered |
Not Covered |
| Kytril* |
Not Covered |
Not Covered |
Covered |
| Letairis* |
Covered |
Not Covered |
Not Covered |
| Leukine* |
Not Covered |
Not Covered |
Covered |
| Leuprolide* |
Covered |
Not Covered |
Covered |
| Lovenox |
Covered |
Covered |
Covered |
| Lucentis * |
Covered |
Not Covered |
Covered |
| Lupron, Depot* |
Covered |
Not Covered |
Covered |
| Macugen* |
Covered |
Not Covered |
Covered |
| Mitoxantrone* |
Covered |
Not Covered |
Covered |
| Monarc-M |
Covered |
Not Covered |
Not Covered |
| Monoclate P |
Covered |
Not Covered |
Not Covered |
| Mononine |
Covered |
Not Covered |
Not Covered |
| Morphine PCA |
Not Covered |
Covered |
Covered |
| Mozobil |
Covered |
Not Covered |
Covered |
| Myozyme* |
Covered |
Not Covered |
Not Covered |
| Naglazyme* |
Covered |
Not Covered |
Not Covered |
| Nebcin* |
Covered |
Not Covered |
Covered |
| Neulasta* |
Covered |
Not Covered |
Covered |
| Neumega* |
Covered |
Not Covered |
Covered |
| Neupogen* |
Covered |
Covered |
Covered |
| Nexavar* |
Covered |
Not Covered |
Not Covered |
| Norditropin* |
Covered |
Not Covered |
Not Covered |
| Novantrone* |
Covered |
Not Covered |
Covered |
| Novarel* |
Covered |
Not Covered |
Not Covered |
| Novoseven |
Covered |
Not Covered |
Not Covered |
| Noxafil* |
Not Covered |
Covered |
Not Covered |
| Nplate* |
Covered |
Not Covered |
Covered |
| Nutropin* |
Covered |
Not Covered |
Not Covered |
| Octagam* |
Covered |
Not Covered |
Not Covered |
| Octreotide* |
Covered |
Not Covered |
Not Covered |
| Omnitrope* |
Covered |
Not Covered |
Not Covered |
| Ondansetron* |
Not Covered |
Covered |
Covered |
| Orencia* |
Covered |
Not Covered |
Covered |
| Orfadin |
Covered |
Not Covered |
Not Covered |
| Orthovisc |
Covered |
Not Covered |
Covered |
| Ovidrel |
Covered |
Not Covered |
Not Covered |
| Panglobulin* |
Covered |
Not Covered |
Not Covered |
| Peg-Intron* |
Covered |
Not Covered |
Not Covered |
| Pegasys* |
Covered |
Not Covered |
Not Covered |
| Perforomist |
Not Covered |
Covered |
Covered |
| Polygam* |
Covered |
Not Covered |
Not Covered |
| Pregnyl* |
Covered |
Not Covered |
Not Covered |
| Prialt* |
Not Covered |
Not Covered |
Covered |
| Privigen* |
Covered |
Covered |
Not Covered |
| Procrit* |
Covered |
Covered |
Covered |
| Profasi HP* |
Covered |
Not Covered |
Not Covered |
| Profilnine |
Covered |
Not Covered |
Not Covered |
| Prolastin* |
Not Covered |
Not Covered |
Covered |
| Proleukin* |
Covered |
Covered |
Covered |
| Promacta* |
Covered |
Not Covered |
Not Covered |
| Proplex |
Covered |
Not Covered |
Not Covered |
| Pulmozyme* |
Covered |
Not Covered |
Not Covered |
| Raptiva |
Covered |
Not Covered |
Not Covered |
| Rebetol* |
Covered |
Not Covered |
Not Covered |
| Rebif* |
Covered |
Not Covered |
Not Covered |
| Recombinate |
Covered |
Not Covered |
Not Covered |
| Refacto |
Covered |
Not Covered |
Not Covered |
| Remicade* |
Covered |
Not Covered |
Covered |
| Remodulin* |
Covered |
Not Covered |
Not Covered |
| Revatio* |
Covered |
Not Covered |
Not Covered |
| Revlimid* |
Covered |
Not Covered |
Not Covered |
| Ribapak* |
Covered |
Not Covered |
Not Covered |
| Ribasphere* |
Covered |
Not Covered |
Not Covered |
| Ribavirin* |
Covered |
Not Covered |
Not Covered |
| Rituxan* |
Covered |
Not Covered |
Covered |
| Roferon-A* |
Covered |
Not Covered |
Not Covered |
| Saizen* |
Covered |
Not Covered |
Not Covered |
| Sandostatin, LAR* |
Covered |
Not Covered |
Not Covered |
| Sensipar |
Covered |
Not Covered |
Not Covered |
| Serostim* |
Covered |
Not Covered |
Not Covered |
| Simponi* |
Covered |
Not Covered |
Not Covered |
| Somatuline* |
Covered |
Not Covered |
Not Covered |
| Somavert* |
Covered |
Not Covered |
Not Covered |
| Sporanox* |
Not Covered |
Covered |
Not Covered |
| Sprycel* |
Covered |
Not Covered |
Not Covered |
| Stimate Nasal Spray (Under age 19)* |
Covered |
Not Covered |
Not Covered |
| Supartz |
Covered |
Not Covered |
Covered |
| Supprelin LA* |
Covered |
Not Covered |
Covered |
| Sutent* |
Covered |
Not Covered |
Not Covered |
| Synagis* |
Covered |
Not Covered |
Not Covered |
| Synvisc |
Covered |
Not Covered |
Covered |
| Tarceva* |
Covered |
Not Covered |
Not Covered |
| Tasigna* |
Covered |
Not Covered |
Not Covered |
| Temodar* |
Covered |
Not Covered |
Not Covered |
| Testopel* |
Not Covered |
Covered |
Not Covered |
| Tev Tropin* |
Covered |
Not Covered |
Not Covered |
| Thalomid* |
Covered |
Not Covered |
Not Covered |
| Tobi* |
Covered |
Not Covered |
Not Covered |
| Torisel* |
Not Covered |
Not Covered |
Covered |
| Tracleer* |
Covered |
Not Covered |
Not Covered |
| Treanda* |
Covered |
Not Covered |
Covered |
| Trelstar LA DEPOT* |
Not Covered |
Not Covered |
Covered |
| Tykerb* |
Covered |
Not Covered |
Not Covered |
| Tysabri* |
Covered |
Not Covered |
Covered |
| Vantas* |
Covered |
Not Covered |
Covered |
| Vectibix* |
Covered |
Not Covered |
Covered |
| Velcade* |
Covered |
Not Covered |
Covered |
| Venoglobulin S* |
Covered |
Not Covered |
Not Covered |
| Ventavis* |
Covered |
Not Covered |
Not Covered |
| Viadur* |
Not Covered |
Not Covered |
Covered |
| Vidaza* |
Covered |
Not Covered |
Covered |
| Vivaglobin* |
Not Covered |
Not Covered |
Covered |
| Vivitrol, M* |
Covered |
Not Covered |
Not Covered |
| Xeloda* |
Covered |
Not Covered |
Not Covered |
| Xenazine* |
Covered |
Not Covered |
Not Covered |
| Xolair* |
Covered |
Not Covered |
Not Covered |
| Xyntha |
Covered |
Not Covered |
Not Covered |
| Xyrem* |
Covered |
Not Covered |
Not Covered |
| Zemaira* |
Covered |
Not Covered |
Covered |
| Zoladex* |
Covered |
Not Covered |
Covered |
| Zolinza* |
Covered |
Not Covered |
Not Covered |
| Zorbtive* |
Covered |
Not Covered |
Not Covered |
|
