Specialty drugs are managed differently than everyday prescriptions. UnitedHealthcare broadly defines "specialty drugs" as:
- Self-administered injectable drugs. These are drugs that can be administered by the patient or a non-skilled caregiver. Self-administered injectable drugs are covered under the pharmacy benefit or may be excluded from coverage; a limited number of self-administered injectable drugs may also be covered under the medical benefit.
- Injectable drugs (not intended for self-administration). These are drugs that must be administered by a healthcare professional in a physician's office or other outpatient setting, usually by infusion or intra-muscular injection. This includes plasma or recombinant-derived products, such as factors to treat hemophilia or immune globulins. Chemotherapy agents are a significant component of this category. Injectable drugs are covered under the medical benefit with the deductible and coinsurance applied.
- Biotech drugs. These are drugs manufactured through genetic engineering. This includes oral, self-administered, injectable or infusion products given in an ambulatory setting.
- Orphan drugs. These are drugs that have been given a seven-year market exclusivity by the Orphan Drug Act.
Based on stipulations of the pharmaceutical manufacturers, certain specialty medications are only available through select specialty pharmacies.
Patient education materials are provided with specialty medications along with information on how to contact the appropriate specialty pharmacy, which differ by type of medication. Pharmacists are available 24 hours a day, seven days a week, to answer any questions and provide information about the medication, such as administration, storage, general drug information and side effect management.
Certain medical conditions require specialty medications, such as anemia, asthma, cancer, cystic fibrosis, growth hormone deficiency, hemophilia, hepatitis C, HIV/AIDS, immune deficiencies, low white blood cells, multiple sclerosis, osteoporosis, psoriasis, pulmonary hypertension, rheumatoid arthritis and RSV prevention to name a few. Note that some drugs may be excluded from coverage under our plan. Please contact UnitedHealthcare (UHC) Customer Service at 800 387 7508 for more information.
When a patient who needs a specialty medication is identified by UnitedHealthcare, UHC's specialty pharmacy contacts the physician to provide information, make initial transition plans and obtain a prescription(s). UHC's specialty pharmacy then contacts the patient to answer any questions and inform him or her of the process. For more information contact UHC Customer Service at 800 387 7508.
Pharmacy customer service centers are open 24 hours a day, seven days a week, except for Thanksgiving and Christmas days. Specialty pharmacies guarantee round-the-clock access to a pharmacist for any medication or administration-related questions.
Please note that there is a Coupon Adjustment Benefit Plan Protection program for prescriptions filled through UHC's specialty pharmacy, OptumRx Specialty Services. Through this program, if a manufacturer drug coupon or manufacturer copay card is used, the drug manufacturer drug coupon or copay card dollar amount will not apply to your deductible and/ or out-of-pocket maximum amounts. Only your actual payment amount (after the coupon is applied) will apply to the deductible and out-of-pocket maximum amounts.