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New specialty pharmacy policy

April 2011

To ensure consistency in how specialty medicines are covered, HealthPartners has implemented a new policy for self-administered medicines. This policy went into effect at the beginning of the year and requires claims for certain self-administered injectable medicines be submitted through pharmacy benefits instead of medical benefits. By having these submitted as a pharmacy claim, the appropriate cost-sharing and coverage criteria will be applied.

Additionally, it requires that members get their self-administered medicines from a pharmacy rather than during an office visit with their health care provider. Medicines on the Specialty Medication List should be filled at Walgreens Specialty Pharmacy with the exception of growth hormones, which must be filled at HealthPartners Riverside Pharmacy. This change includes chronic inflammatory disease medicines Enbrel and Humira; multiple sclerosis medicines Betaseron, Extavia and Copaxone; all growth hormones and a few other specialty medicines all included on the Specialty Medication List.

While these medications are not highly used – they do incur high costs. HealthPartners will continue to actively manage these specialty medications in both the retail and in-clinic settings. If you have any questions or would like to see the full list of affected specialty medications, please contact your HealthPartners sales executive or your broker.

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