Your doctor has prescribed you a specialty medication. Because specialty medications are complex and expensive, insurers often required additional approvals before the specialty pharmacy can provide you with your medication.
Specialty pharmacies have specially trained teams who work behind the scenes to get the approvals necessary. Once the steps below are complete, they will contact you to schedule delivery.
Here’s what a specialty pharmacy is doing behind the scenes to process your prescription:
1. Benefits verification
- They’ll check your prescription benefit plan to make sure your medication is covered. If needed, they can also look at your medical benefits for drug coverage.
- They’ll confirm how much your medication will cost. They’ll check what your plan covers and how much you’ll need to pay. Everyone's benefits and coverage plans are different. That’s why this step is so important.
- Your specialty pharmacy can also help you research and find financial resources as needed, like Patient Assistance Programs.
2. Prior authorization
- Most insurers require what’s called a prior authorization (or PA) before they’ll cover your specialty medication. This allows your insurer to review if the prescribed medication is needed for your condition. This is very common with specialty medications as they are complex and often costly.
- If a PA is needed, your specialty pharmacy will work with your doctor to submit the required information to your insurer. It can take 5-10 business days for your insurer to approve or deny the request.
- Watch a quick video to learn more.
CVS Specialty has dedicated CareTeam members who are specially trained in getting prescriptions filled quickly and efficiently. Plus, you have a choice on how you get your medication. You can have it delivered to any place nationwide, even if you’re on vacation. Or you can pick it up at any CVS Pharmacy® location.*