Many complex conditions are treated with specialty medications. Specialty medications are FDA approved drugs including Biosimilars that are typically injectable medications administered either by you or a health care professional, and they often require special handling. Conditions commonly requiring specialty medications include:
Medications classified by the State Health Plan as specialty or Biosimilar medications meet all of the following conditions:
Treats complex medical conditions(s)
Requires frequent clinical monitoring, e.g. dosing adjustments
Requires special patient education, training and/or coordination of care
Generally prescribed by a specialist provider
The State Health Plan designates between self-administered specialty medications and provider-administered specialty medications for benefit coverage. Please refer to the Specialty Drug List and Specialty Quantity Limit Drug List.
Using CVS Specialty Pharmacy
CVS Specialty Pharmacy, the State Health Plan's Specialty Pharmacy, deals exclusively with supplying medications to treat complex conditions and provides a high level of care for patients with chronic or serious conditions, who take medications that require injection, special handling and monitoring.
Plan members must use CVS Specialty for all non-acute, self-administered specialty medications filled under the pharmacy benefit, excluding medications used to treat cancer. If a member uses a pharmacy other than CVS Specialty Pharmacy to purchase any of the specialty medications listed, they will be responsible for paying the total amount of the prescription at the time of purchase.
Services provided by CVS Specialty Pharmacy include:
An on-call pharmacist to answer questions 24 hours a day, 7 days a week
Personalized counseling from a team of registered nurses and pharmacists
Coordination of home care and other health care services, when appropriate
Expedited, scheduled delivery of your medications at no additional cost
Refill reminder call
It's easy to get started using CVS Specialty. There are two options to contact CVS Specialty: