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 and some oral medications for conditions such as cancer, rheumatoid arthritis and multiple sclerosis.
The average cost is over $1,500 per month per prescription. Less than 2% of U-M drug plan members use specialty drugs, which represent 16% of all plan drug costs.
To better support our plan members and help manage the growing cost of specialty drugs, medications on the U-M Specialty Drug List written by physicians outside of the University of Michigan Health System will only be covered at Wellpartner, a mail order specialty drug pharmacy based in Portland, Oregon that will fill and ship prescriptions directly to a patient (U.S. addresses only). Prescriptions written by a University of Michigan Health System physician will only be covered at pharmacies at the U-M East Ann Arbor Health Center, U-M Cancer and Geriatrics Center, or U-M Ambulatory Care Pharmacy in the Taubman Center.
What is a “specialty” drug?
A specialty drug is a prescription drug that is either a self-administered 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. The 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 drugs for varying conditions. Some infertility medications also are on the Specialty Drug List.
Any required prior authorizations (PAs) noted on the Specialty Drug List next to the drug name. Your physician must call MedImpact Member Service at 1-800-681-9578 to obtain prior authorization (PA) on your behalf when required.
Why does my specialty drug prescription have to be filled at a designated pharmacy?
The University of Michigan Health System receives special drug discounts that can help the university control overall spending on drugs for members of the U-M Prescription Drug Plan. To receive special pricing under federal programs, prescriptions for for specialty drugs filled at a U-M Health System pharmacy must be written by a U-M physician. Prescriptions written by a physician outside the U-M Health System do not qualify for this program, and must be filled at Wellpartner under a separate arrangement. Wellpartner and the U-M pharmacies will ship specialty drugs, free of shipping charges, directly to patients with U.S. addresses.
Where can my specialty drug prescription be filled?
Drugs on the U-M Specialty Drug List will only be covered at Wellpartner for prescriptions written by physicians outside the U-M Health System or a U-M Health Systems pharmacy at the East Ann Arbor Health Center, Cancer and Geriatrics Center, or the Ambulatory Care Pharmacy in the Taubman Center for prescriptions written by a U-M physician.
Patients must be registered with Wellpartner before the doctor can fax new prescriptions to Wellpartner. Patients can register with Wellpartner via phone or online; original prescriptions must be mailed to Wellpartner or ask your doctor’s office to call or fax it in directly.
If your covered drug is not on the U-M Specialty Drug List, it can be filled at any pharmacy in the University of Michigan drug plan network. Wellpartner cannot fill non-specialty drug prescriptions for you at this time. 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
How much medication can I get filled each time?
Specialty drugs are limited to 34 days per fill, except for immunosuppressant drugs which are covered for up to 90 days. Check the U-M 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) should dial 711.
What patient services will be provided?
Wellpartner or your U-M Health System pharmacy will fill your specialty drug prescription and provide specialty drug therapy support including:
- Free delivery of specialty drug directly to a patient’s home, or another U.S. address of your choice. Drugs filled at a U-M Health System pharmacy may also be picked-up at the pharmacy.
- Prompt and personalized telephone access
- Wellpartner: Monday through Friday, 10:00 AM to 8:00 PM Eastern Time
- U-M Health System pharmacies: Monday through Friday, 9:00 AM to 5:30 PM Eastern Time and Saturday 8:30 AM to 12:30 PM Eastern Time
- Pharmacist telephone support for medication information
- Coordination of refills to help manage medication schedule
Co-pays and Generic Medications
Your pharmacist will dispense generic drugs whenever they are available and permitted, and you pay the generic co-pay amount unless your physician specifies “dispense as written” (DAW) on your prescription or you request the brand product. Some brand products with generic equivalents available may be assessed a “product selection penalty” (the difference in cost between the brand and the generic drug) in addition to the co-pay.
Co-pay tiers for specialty medications are shown on the U-M Specialty Drug List . You also can use the “Drug Price Check” feature on the MedImpact website for U-M members: https://mp.medimpact.com/umh
If you have questions, please contact MedImpact Member Service at1-800-681-9578. Plan participants using a telecommunications device for the deaf (TDD) should dial 711.