Specialty medications are drugs that treat chronic, complex conditions. They require frequent dosage adjustments, clinical monitoring, specialty handling, and are often unavailable at retail pharmacies.
Accredo is ESI's home delivery specialty pharmacy provider. Specialty drugs must be filled through Accredo. If ESI has identified your medication as being needed immediately, you may get the first fill at a retail pharmacy. After that first fill, you must get that specialty medication through Accredo. Members who continue to go to a retail pharmacy will be charged the full discounted price of the specialty drug.
Preauthorization is required.
Your provider may advise you to stop taking a specialty medication before a 30-day supply is depleted, typically due to undesirable side effects or lack of effectiveness.
To help avoid cost for medications that will go unused and to reduce waste, the split-fill program allows members to order a 15-day supply of a specialty drug at a time, rather than a full 30-day supply. The copayment is prorated based on the given days' supply dispensed. For example, if the copayment is $35 for a 30-day supply, you pay $17.50 for the first 15-day supply and $17.50 for the second 15-day supply, if a second supply is filled.
For the first three (3) months of taking a new prescription, you will be in regular contact with a Therapeutic Resource Center (TRC) - specialist pharmacists, nurses and doctors - as well as your own health care provider, in order to monitor for any potential complications. By the fourth month, if the medication is to be continued, a full 30-day supply must be ordered.
The split-fill program only applies to specialty drugs that are packaged to allow split-filling and those that are filled through the Accredo specialty mail order pharmacy, beginning with the first fill.
Copyright © Missouri Consolidated Health Care PlanBack to Top