Beginning July 1 prescriptions for medications on the U-M Specialty Drug List written by prescribers outside of the U-M Health System will be covered only when filled by Wellpartner, a specialty drug pharmacy that will ship specialty prescription drugs directly to the patient with no shipping fees.
Prescriptions written by a UMHS prescriber will be covered when filled at the U-M East Ann Arbor Health Center pharmacy, U-M Cancer Center pharmacy or Ambulatory Care pharmacy.
Several categories of medications covered by the university’s prescription drug benefit are considered specialty drugs, which require special handling, administration or monitoring. Examples include oral and injection cancer drugs; anticoagulant, hematopoietic and immunosuppressive drugs; growth hormones; drugs for arthritis, psoriasis, cystic fibrosis, hepatitis B, hepatitis C, multiple sclerosis, and pulmonary hypertension; and certain infertility medications.
Prescriptions for all non-specialty medications can continue to be filled at any pharmacy in the U-M Prescription Drug Plan’s broad network of pharmacies. Wellpartner is not authorized to fill non-specialty drugs at this time.
Although less than 2 percent of U-M Prescription Drug Plan members use specialty drugs, they represent 16 percent of plan claim costs. The average cost of specialty drugs is more than $1,500 per month per prescription. Using the buying power of the U-M Hospitals and Health Centers and a single specialty drug provider, the university can control overall spending better on these increasingly expensive drug classes, while delivering important medications to patients.
Prescribers with patients in the U-M Prescription Drug Plan who currently are using a specialty drug have been notified of this change. In June informedRxU+00C2U+00AE, an SXC Health Solutions Company, will send information about the new specialty drug service to all U-M Prescription Drug Plan members who currently receive specialty medication.
The UMHS pharmacy and Wellpartner will fill specialty drug prescriptions and provide specialty drug therapy support, including personalized telephone access and coordination of refills to help manage patient medication schedules.
Effective July 1 a co-pay for specialty drugs will apply at all pharmacies. Pharmacists will dispense generic drugs whenever they are available and permitted, and U-M prescription drug plan members pay the lower generic co-pay amount, unless their physicians specifiy “dispense as written” (DAW) on the prescription, or the patient requests the brand product. Co-pays for specialty medications can be found on the “What’s My Copay” feature on the RxPortal Web site: https://umi.rxportal.sxc.com.
For more information about specialty drugs, contact the informedRx member call center toll-free at 866-715-0874. Plan members using a telecommunications device for the deaf (TDD) should call 866-261-0791. The U-M Specialty Drug List is available on the Benefits Office Web site at benefits.umich.edu.
