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Knowledge Center Understanding specialty pharmacies

Learn how specialty pharmacies are different than traditional ones and how insurance can help you get the specialty medicine you need.

What is a specialty pharmacy?

If you have a serious health problem like cancer, multiple sclerosis, or rheumatoid arthritis, your care probably includes specialty medications.

Unlike more common medicines, these drugs may need to be injected or given through an IV. They may also require special handling and storage.

Since these medications require an extra level of care, you'll need to get them from a specialty pharmacy instead of a regular one. These pharmacies are designed to handle complex medications and support the people who need the prescriptions.

Specialty services commonly available

Specialty pharmacies don't just fill your prescriptions. Their goal is to make managing a health condition easier. To support their patients and help them with their medications, services they normally offer include:

Patient education

Taking multiple medications, especially when they are injections or infusions, can be confusing. Medication therapy management from a specialty pharmacy teaches how to use and store the medicine correctly.

24/7 support

While most specialty pharmacies aren't open 24/7, many do offer 24/7 support online or by phone to answer any questions or concerns. These services shouldn't be used in place of 911 if there is a medical emergency.

Helping with insurance coverage

Specialty pharmacies often have staff who help patients understand their insurance coverage. They can help you figure out what insurance pays for and what you might have to pay yourself.

Getting prior authorization

Some health insurance plans need to approve a medication before a patient can get it. The specialty pharmacy can talk to your doctor to get all the information to request the prior authorization for you.

Using your insurance at specialty pharmacies

Getting specialty medications can feel a little different than picking up a regular prescription. Here's what to know about using your insurance, working with your pharmacy, and keeping costs manageable.

Getting your medication

Start by checking which specialty pharmacies are in your network. Then take a look at your plan's list of covered medications to see if your prescription needs approval first.

Once your prescription is approved, you can talk to the pharmacist to get your medicine. They will also teach you how to take it the right way.

Some medications may be sent directly to your home or doctor's office. Injectable or infusible medications are normally sent to the doctor's office or hospital for use.

Managing costs

Specialty drugs typically cost more than a regular prescription. In some cases, there may be payment assistance programs that can help lower your costs that the pharmacy can help you with.

If you have any questions about what your insurance pays for and what you need to pay, you should also contact your insurance company.

Learn more about prescription costs
Take the confusion out of insurance

Get reliable answers to your insurance questions, such as how to get prior authorization and submitting a claim.

The appeals process

Was your claim denied when you think it should have been approved? You can submit an appeal. Learn more about how to file an appeal and what steps to take next.

Pharmacy benefits

Pharmacy benefits don't have to be confusing. Learn more about your Blue Cross NC prescription benefits and how to get your medications.

How to request non-formulary drugs

Your doctor may suggest you take some non-formulary drugs, or those not on your approved list. Learn how to request coverage of non-formulary medications.

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Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.

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