U-M Specialty Drug Program ‘Frequently Asked Questions’
Specialty drugs are a covered benefit in the U-M Prescription Drug Plan. These medications require special handling, administration or monitoring and include self-injection (non-diabetes) and some oral medications for conditions such as cancer, rheumatoid arthritis and multiple sclerosis.
The average cost for specialty drugs is over $2,000 per month per prescription. Less than 2% of U-M Prescription Drug Plan members use specialty drugs, which represents more than 20% of all plan drug costs.
To better support plan members and help manage the growing cost of specialty drugs, medications on the U-M Prescription Drug Plan Specialty Drug List will only be covered when filled at University of Michigan Health System (UMHS) Specialty Pharmacy Services. Specialty medications may be shipped directly to a patient’s U.S. address with no shipping fees, or members can walk-in and pick up their specialty medication(s) at the pharmacy during business hours.
What is a specialty drug?
A specialty drug is a prescription drug that is either a self-administered (non-diabetes) injectable medication; a medication that requires special handling, special administration, or monitoring; or, is a high-cost oral medication. The U-M Prescription Drug Plan Specialty Drug List is published on the Benefits Office website at benefits.umich.edu/forms/specialtydrugs.pdf. This list is subject to change.
Which drugs are included in this specialty drug program?
The U-M Prescription Drug Plan Specialty Drug List covers several categories of drugs, including: oral and self-injectable cancer drugs; anticoagulant, hematopoietic, and immunosuppressive drugs; growth hormones; drugs for rheumatoid arthritis, psoriasis, cystic fibrosis, hepatitis, multiple sclerosis, pulmonary hypertension; and, other oral and self-injectable (non-diabetes) drugs for varying conditions. Some infertility medications also are on the U-M Specialty Drug List, please click here for more information.
Any specialty medications that require prior authorization (PA) are noted on the U-M Prescription Drug Plan Specialty Drug List next to the drug name. Your physician must call MedImpact Member Service at 1-800-681-9578 to obtain prior authorization on your behalf when required.
How much specialty drug medication can I get filled each time?
Specialty drugs are limited to 34 days per fill, except for immunosuppressive drugs which are covered for up to 90 days per fill. You can check the U-M Prescription Drug Plan Specialty Drug List or call MedImpact Member Service at 1-800-681-9578 for specific information on maximum days supply covered for your medication. Plan participants using a telecommunications device for the deaf (TTY) may dial 711.
Where can my specialty drug prescription be filled?
Prescription medications on the U-M Prescription Drug Plan Specialty Drug List will only be covered when filled at UMHS Specialty Pharmacy Services. Specialty medications may be shipped directly to a patient’s U.S. address with no shipping fees, or members can walk-in and pick up their specialty medication prescriptions at the pharmacy during business hours. Exceptions include some infertility medications and/or specialty drugs that are restricted by the manufacturer to be filled at certain pharmacies (“limited distribution drugs”). Please see the U-M Prescription Drug Plan Specialty Drug List for more information.
Patients must be registered with UMHS Specialty Pharmacy Services before your doctor can call, fax or electronically prescribe new specialty medication prescriptions to the pharmacy. Patients can register with UMHS Specialty Pharmacy Services via phone by calling the number listed on the specialty pharmacy contact information page.
To learn more about mail order options for non-specialty medications please visit the Benefits Office website at: benefits.umich.edu/plans/drugs/mailorder.html
Why does my specialty drug prescription have to be filled at UMHS Specialty Pharmacy Services?
The average cost for specialty drugs is over $2,000 per month per prescription. Less than 2% of U-M Prescription Drug Plan members use specialty drugs, which represents more than 20% of all plan drug costs. Using a designated specialty pharmacy enables the U-M Prescription Drug Plan to better support plan members and help manage the growing cost of specialty drugs. The U-M Health System receives special price discounts that can help the university control overall spending on drugs for members of the U-M Prescription Drug Plan.
What if my physician is not part of the U-M Health System?
Your physician does not need to be located at a U-M Health System facility for you to use UMHS Specialty Pharmacy Services, and you do not need to change your physician to receive your specialty medication(s). The UMHS Specialty Pharmacy Services will provide specialty medications to members regardless of where your physician is located.
What patient services does UMHS Specialty Pharmacy Services provide?
UMHS Specialty Pharmacy Services has a staff of financial coordinators to offer financial counseling and support services (eg, copay discount cards, PA approvals) as well as clinical programs and services to members for improved disease state and drug therapy management for complex health conditions.
UMHS Specialty Pharmacy Services will fill your specialty drug prescription and provide specialty drug support services including:
- Free delivery of specialty drugs directly to a patient’s home, or another U.S. address of your choice.
- Specialty drugs filled at a UMHS Specialty Pharmacy Services may also be picked-up at the main pharmacy location at East Ann Arbor Health and Geriatrics Center 4260 Plymouth Road in Ann Arbor, MI during business hours.
Monday through Friday: 9:00 AM to 5:30 PM Eastern Time
Saturday: 8:30 AM to 12:30 PM Eastern Time
- Pharmacist telephone support for medication information
- Coordination of refills to help manage medication schedule
How will UMHS Specialty Pharmacy Services use my personal information?
Please be assured that your privacy is protected. If your current physician is outside of the U-M Health System, your personal information is stored in the pharmacy only, and is not part of the hospital patient record system. Your protected health information will not be shared with anyone outside your physician’s office without your permission.
If you have questions, please contact MedImpact Member Service at1-800-681-9578 or visit the MedImpact member website. Plan participants using a telecommunications device for the deaf (TDD) may dial 711.