Getting started with CVS Specialty®
A specialty medication is used to treat complex and chronic conditions like rheumatoid arthritis, multiple sclerosis, human immunodeficiency virus (HIV), psoriasis, rare genetic disorders, infertility and cancer. A specialty medication is sometimes taken as a pill but is most often injected or infused. It tends to be high cost and those who take specialty medications may need extra monitoring or support.
You can check the CVS Specialty Drug List to see if your medication is available through CVS Specialty by signing into CVSspecialty.com.
Please note: Most specialty medications require prior authorization (PA) before they can be covered by your plan. This means that your doctor must provide more information to your insurance company or pharmacy benefit manager on why you need a specialty medication. On average, the process takes about a week for your insurance company to approve or deny the request. But we’ll work to get your medication to you as quickly as possible. If approved, your medications will be covered based on your plan and we’ll contact you to schedule delivery.
CVS Specialty offers a higher level of support than traditional retail pharmacies. You’ll have access to a CareTeam, which includes clinical pharmacists and nurses who are specially trained for conditions like yours. They can help with everything from getting started, setting up injection training or home infusions, helping you manage side effects and connecting you with financial assistance programs.
Here’s how the process works:
When CVS Specialty receives your prescription, a member of your CVS Specialty CareTeam will call you. Our team will welcome you, verify your information to protect your privacy and let you know what services we can provide. We’ll ask how you prefer to receive updates on your prescriptions – by text message, email or both. We will send you a link to get started at CVSspecialty.com.
We’ll review your prescription and insurance information and see if your medication needs a prior authorization. If so, we’ll ask your doctor to submit a request. You’ll also find out how to pay for your medication. If you need help paying for your medication, we can help you find financial assistance from the manufacturer or other patient assistance programs.
If your medication is injected or infused, we can also help you set up any services you or your caregivers may need at home – like self-injection training or infusion assistance. If you need supplies or nursing orders, we’ll request them from your doctor.
Our team will ask some questions about your health. This will help your CVS Specialty pharmacists review your medications to help make sure they don’t interact with your health or your other medications. These questions may include:
- Do you have any vision or hearing issues that we should be aware of?
- Do you have any allergies?
- What other medications do you take (if any)?
- Do you have any questions for the pharmacist about the medication or how to use it?
The next step is to schedule delivery. Your medication can be sent to your home or work address, your doctor’s office or even a CVS Pharmacy® store*. If your medication has any special storage requirements, the representative will review those with you. They will also review your payment and billing information. If you chose to receive text or email communications, you’ll get a message and tracking number when your package ships.
*Where allowed by law. In-store pick up is currently not available in Oklahoma. Puerto Rico requires first-fill prescriptions to be transmitted directly to the dispensing specialty pharmacy. Products are dispensed by CVS Specialty and certain services are only accessed by calling CVS Specialty directly. Certain specialty medication may not qualify. Services are also available at Long’s Drugs locations.
Creating an online account
Registering makes it easier to manage your prescriptions and view all the information you need in one place. You can use the website or mobile app to refill prescriptions and check the status of your prescription order so you know when it’ll be ready. You also have access to a CVS Specialty CareTeam that specializes in conditions like yours. Our site is secure to protect your privacy, so you can securely send messages to your CareTeam to ask questions about your health or medication.
Prescriptions and refills
We’ll send a reminder before your refill is due based on your preferences (i.e., email, text or phone). To order your refill, sign in to CVSspecialty.com or use the CVS Specialty app. These are the easiest ways to refill your prescription.
When you request your refill, we’ll ask you some questions, such as:
- Would you like your medication shipped or picked up at a CVS Pharmacy store?
- By what date do you need to have your medication?
- Do you have any questions for the pharmacist?
- Have you noticed any mental or physical side effects?
If it’s a prescription for a medication you’re already taking, it may not be ready to refill yet. You can only see medications with an eligible refill in your online account. If you’re starting a new medication and it’s urgent, make sure your doctor already sent the prescription to CVS Specialty and ask them to call us to follow up.
Certain medications cannot be filled online. Some examples include:
- Medications that are meant to be filled only one time
- Medications used for fertility treatment
- Medications that need frequent monitoring
If you see Please Call for Refill, your medication may need special handling, so you won’t be able to refill it online. You will need to call the phone number on your prescription label.
You can refill active prescriptions when they are ready for refill. They’ll be listed in the My Prescriptions tab with a red Refill button next to them. If you have multiple prescriptions ready for refill, you can click the Refill All button. Prescriptions you’ve refilled before, but aren’t yet ready to be refilled again, will appear under Recent Prescriptions.
If you see Please Call for Refill, your medication may need special handling, so you won’t be able to refill online. You will need to call the phone number on your prescription label.
Sign in and click on My Prescriptions. Once your order has a tracking number, you can click on a link to the shipper’s website for more information. It may take some time for shipping details to appear. You can also get text alerts about your prescription order status sent to your mobile device. To start text alerts, sign in and click My Account and check the I Want to Receive Text Alerts box.
CVS Specialty does not offer automatic refills. For your specialty medication, we need to gather up-to-date clinical information to provide the highest level of care with every prescription refill. We will send a reminder before your refill is due based on your preferences (i.e., email, text or phone). You can then complete the order online or by calling us.
To start receiving email or text alerts, once signed into your account, go to My Account and click on Edit under My alert preferences or send us a secure message.
When you place your order online, please be sure the supplies you need appear at checkout – they are not automatically included. If you have to place your order by phone, your CVS Specialty CareTeam will confirm any supplies you need.
CVS Specialty will file claims with your insurance company (i.e., insurer). We will contact your insurer to find out what is covered and if any paperwork is needed. If a claim is denied, we will work to try and get it approved for you or will work with your doctor to try and find another medication that’s covered and appropriate for you.
Your insurer may give you an explanation of benefits (EOB) report that describes covered services and how much was paid. We’ll provide you with a statement if there is an amount you need to pay.
Sign into your account and send us a secure message. You can send us a picture of the front and back of your new insurance card or type in the details including insurance name, ID, group, BIN, PCN and phone numbers.
There are a few things you can do:
- Keep us updated on your insurance when you place your order. This includes any changes to your insurance, a copay assistance card or other insurance you may have.
- Have your insurance information handy when you talk to us.
- Contact your insurer as needed. We work with your insurer behind the scenes, but sometimes your insurer may need information directly from you. We’ll let you know if that’s the case. Once your insurer has all the information from you, we can continue processing your order.
Prior authorization is a review process your health plan uses to help make sure the medications, tests and treatments you get are appropriate and affordable.
Prior authorization can help you:
- Get your prescription covered by your plan, which may offer lower out-of-pocket costs.
- Get clinically appropriate medication for your condition.
- Your health care provider or your specialty pharmacy sends a prior authorization request to your health plan.
- Your health plan reviews this request to make sure your medication meets requirements for approval.
- Prior authorization is considered pending while you wait for your health plan’s decision.
- After your health plan completes the review, they’ll notify you and your health care provider of their decision.
Typically, you do not need to act while you wait for your health plan’s decision. If we require information from you, we’ll send you a secure message or call you with specific instructions. You can watch this video to learn more about prior authorization, different prior authorization outcomes and how CVS Specialty supports you throughout this process.
After the review, your prior authorization will either be approved or denied.
- If your prior authorization is approved, we will fill your prescription and update you when it’s ready to schedule.
- If your prior authorization is denied, you and your prescriber will get a letter with next steps, including instructions to make a formal appeal.
Your cost will be determined once your order is processed and billed to your insurer.
It may take a few days for your payment to show on your account. We’ll send you a receipt (based on your preference) when your payment has been processed and billed to your insurer. You can check your account balance by signing into your account, select Balance and Payments on your home page.
For online payments, we accept VISA credit/debit cards, MasterCard credit/debit cards, American Express, Discover or electronic check. If you pay by mail or over the phone, we also accept checks and health savings account (HSA) or flexible spending account (FSA) cards. CVS Specialty accepts money orders by mail only. Copay assistance or drug manufacturer debit cards may be accepted by calling the Billing department at 1-800-250-9631 (TTY: 711).
Yes. You can choose to schedule payments on a specific day every month for either a specific amount or for the balance owed on your account up to a pre-authorized amount.