Specialty pharmacy is a continued area of focus at HealthPartners as the industry continues to see significant cost increases for specialty medications. Although only a small number of prescriptions drive that increase, specialty medications are the fastest growing segment of the pharmaceutical industry.

The HealthPartners Pharmacy and Therapeutics Committee reviews all drugs. This committee promotes the appropriate use of high-quality and cost-effective pharmaceuticals for HealthPartners members. Self-administered medications are reviewed for formulary status, and all medications are reviewed for coverage criteria. Prior to committee review and coverage determination, all drugs require review for medical necessity and approval to ensure payment.

To reduce costs and ensure knowledgeable pharmacy care, we have made exclusive arrangements with specialty pharmacy providers for self-administered specialty medications.

CVS Caremark Specialty Pharmacy is responsible for providing the majority of specialty medications for HealthPartners members, including self-administered specialty medications. Other pharmacies provide specialty medications when there is additional clinical support or cost benefit.

As of Jan. 1, 2020, self-administered specialty medications may be dispensed from:

Members have the convenience of having self-administered specialty medications delivered directly to their homes for no additional charge. They’ll work with pharmacy teams familiar with their conditions, will have 24-hour access to a pharmacist and will receive monthly refill calls to ensure adherence to the care plan from their provider team.

Local retail pharmacies (e.g. CVS, Walgreens, etc.) cannot process self-administered specialty medication prescriptions for health plan coverage. CVS Caremark does offer delivery to a CVS retail store, but members must make arrangements through CVS Caremark Specialty Pharmacy.

The process may be started by either members or providers. Providers may send referrals or prescriptions directly to the specialty pharmacy or to the manufacturer’s hub or call center. Once the pharmacy or manufacturer receives the form, they’ll contact the member to arrange for the delivery of the medication. All specialty medications and supplies are delivered directly to the home or preferred address.

This program applies only to specialty medications. Members can continue to get all other non-specialty prescription medications through our retail pharmacy networks or mail order via HealthDyne.

This program doesn’t apply to drugs administered by professionals in a home or clinic. Self-administered injectable drugs included in the specialty drug lists are generally not eligible for reimbursement through a medical claim. When in-clinic administration is medically necessary, the drug should be sourced through our specialty pharmacy providers and sent to the clinic for administration. Administration costs are eligible for reimbursement through a medical claim.