What’s a specialty drug?
Specialty drugs are prescribed medicines that treat rare, chronic or complex conditions, such as:
Cancer Cystic fibrosis Hemophilia and other blood clotting disorders- Hepatitis
- Infertility
MS (multiple sclerosis) - Pulmonary hypertension
RA (rheumatoid arthritis)
Specialty medicines are usually taken by mouth or injected. These drugs typically require a higher degree of management from your care team, and they can also come at a higher price. Specialty drugs usually aren’t carried by retail pharmacies. Instead, they’re often carried by specialty pharmacies or administered in health care settings.
- If you have a Medicare plan with us – See our
Medicare Part D formulary page for more details about specialty drugs. - If you have any other plan with us – You can find details about our specialty drug program below.
Identifying specialty drugs and how they’re covered
You can find out which drugs are considered specialty medicines and how they’re covered by
- Specialty medicines covered under your pharmacy benefits – These medicines have a “Specialty Drug” indicator in your formulary.
- Specialty medicines covered under your medical benefits – These medicines have a “MED” indicator in your formulary. Note that some non-specialty medicines also have a “MED” indicator.
For more details about your plan’s pharmacy and medical benefits, you can
Coverage criteria and prior authorization for specialty medicines
Most specialty medicines require
- Specialty medicines covered under your pharmacy benefits – When you
search your plan’s formulary (drug list) , look for a “PA” indicator. Medicines with the “PA” indicator require prior authorization. - Specialty medicines covered under your medical benefits – You can find details about prior authorization requirements by checking our
medical coverage criteria .
If you’re not sure where to look or need help with prior authorizations,
How does the specialty drug program work? What’s a specialty pharmacy?
We partner with specialty pharmacies that safely fill and conveniently deliver your medicines. In addition, specialty pharmacies provide:
- No-cost shipping and handling
- Monthly reorder reminders
- Acceptance of manufacturer coupons
A manufacturer coupon is a coupon issued by a drug company to help you save money on a particular medicine, with the manufacturer absorbing part of the cost. These work with most group and individual and family plans that have prescription drug coverage. They don’t work with Medicare and Medical Assistance (Medicaid) plans.
If you present a manufacturer coupon to your pharmacy, your out-of-pocket cost will typically be the lower of the amount stated on the coupon or your plan’s regular cost-sharing amount for the drug. Amounts paid by manufacturers may not apply to any deductibles or out-of-pocket limits your plan may have.
Not sure if there’s a manufacturer coupon available for your medicine? Ask the pharmacist at your specialty pharmacy. They may be able to see if there’s a coupon available and, if so, help you use it toward your medicine.
HealthPartners plan network specialty pharmacies
This list applies to specialty medicines covered under your pharmacy benefits. (Specialty medicines covered under your medical benefits are typically administered in health care settings.)
Important things to keep in mind
- This list doesn’t apply to employer groups that have unique specialty network requirements. For these groups, you can find your network list among your plan’s documents and resources. If you’re not sure if your employer has a separate specialty pharmacy network,
our Member Services team can help. - In limited instances, CVS Caremark Specialty Pharmacy will have to supply a specialty medicine regardless of the condition being treated. This is due to manufacturer limitations.
Need help?
For questions about your specialty medicine, contact your specialty pharmacy directly.
For questions about your plan’s coverage of specialty medicine,