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Specialty Pharmacy Frequently Asked Questions
What are Specialty Pharmacy Medications?
Why is Synagis considered a Specialty Pharmacy Medication?
Are Specialty Pharmacy Medications listed on Mutual of Omaha’s "formulary"?
Where can a list of the Specialty Pharmacy Medications be obtained?
Do I have to obtain my Specialty Pharmacy Medication from either PharmaCare or Caremark?
What free-of-charge services are offered by Mutual of Omaha’s Specialty Pharmacy Providers?
What Specialty Pharmacy Medications require Prior Authorization?
What do I need to do if I am on a Specialty Pharmacy Medication that requires Prior Authorization?
What are Specialty Pharmacy Medications?
Specialty Pharmacy Medications are medications manufactured often using highly specialized techniques. They were developed to manage or prevent symptoms associated with long term chronic disease states. Many of these medications require frequent clinical monitoring due to side effects. The medication may be self injected or given orally.
Specialty Pharmacy Medications also include medications that cannot be stocked at a local retail pharmacy.
Why is Synagis considered a Specialty Pharmacy Medication?
Synagis is a very costly medication that is only given on a seasonal basis to premature infants who are at high risk of developing RSV (Respiratory Synctial Virus). These infants must meet specific criteria developed by the American Association of Pediatric Physicians in order to receive the medication. Close clinical monitoring is required.
Are Specialty Pharmacy Medications considered retail medications or mail order medications since they are mailed?
Although Specialty Pharmacy Medications are "mailed", such as to the physician’s office or to the patient’s home, they are considered a retail medication because only a 30 day supply of the medication can be dispensed. Mail order medications can be dispensed as a 90 day supply.
Are Specialty Pharmacy Medications listed on Mutual of Omaha’s "formulary"?
Yes.
Where can a list of the Specialty Pharmacy Medications be obtained?
A list of the Specialty Pharmacy Medications as well as Mutual of Omaha’s "formulary" can be found on the Mutual of Omaha website at www.MutualofOmaha.com.
Do I have to obtain my Specialty Pharmacy Medication from either PharmaCare or Caremark?
No. Being a Mutual of Omaha member, you have a choice regarding what pharmacy you would like to obtain your medication from. Utilizing one of Mutual of Omaha’s Specialty Pharmacy Providers will however, maximize your benefit dollars. These providers offer many free-of-charge services to Mutual of Omaha’s members.
What free-of-charge services are offered by Mutual of Omaha’s Specialty Pharmacy Providers?
These providers offer timely, accurate and free courier delivery of medications to your home, your office, your vacation spot, or your doctor’s office - typically within 24 to 48 hours. Additionally, they offer:
- Complete insurance billing, including coordination of benefits
- Education and wellness programs that include information, materials and ongoing support to the member
- Ancillary supplies such as syringes, alcohol swabs, and a Sharps kit
- 24 hour availability
- Dedicated Mutual of Omaha 800 line
- Pharmaceutical consultation services
Will changing to one of Mutual of Omaha’s Specialty Pharmacy providers result in a change in my co-pay?
If you are currently using an out of network provider switching to one of Mutual of Omaha’s Specialty Pharmacy providers may decrease the amount of your co-pay. Please note that benefits are policy specific. For more information regarding co-payment amounts please contact the Mutual of Omaha Customer Service number on the back of your Mutual of Omaha ID card.
What Specialty Pharmacy Medications require Prior Authorization?
Remicade, Enbrel, Botox, Hyalgen, Synvisc, Growth Hormone for members > 18 years of age, Synagis.
What do I need to do if I am on a Specialty Pharmacy Medication that requires Prior Authorization?
Contact the Mutual of Omaha Customer Service number on the back of your Mutual of Omaha member identification card.
If I have a drug card through Mutual of Omaha will a Specialty Pharmacy Medication be able to be obtained using the card?
Yes, but only if the medication is being provided by a Mutual of Omaha participating pharmacy or participating Specialty Pharmacy Provider.
If my physician’s office is going to provide the Specialty Pharmacy Medication will I still be able to use my drug card?
No. Physician’s offices do not have the capabilities to submit charges under a member’s drug card. The physician’s office would submit the claim and the claim would be processed under the Major Medical provision of the member’s policy.
Who may I contact for questions concerning the handling of a request for a Specialty Pharmacy Medication?
Contact the Mutual of Omaha Customer Service number on the back of your Mutual of Omaha member identification card.
What process do I need to follow to get my Specialty Pharmacy medication from one of Mutual of Omaha’s Specialty Pharmacy Providers?
After choosing one of Mutual of Omaha’s Specialty Providers to meet your unique needs, you will need to:
- Notify your physician’s office which provider you have chosen to provide your Specialty Pharmacy medication.
- You will need to provide to the physician’s office the phone number or the fax number of the Specialty Pharmacy provider you have chosen.
- PharmaCare
Phone: (888) 900-3232
Fax: (800) 862-1249 - CAREMARK
Phone: (866) 322-0984
Fax: (800) 323-2445
- PharmaCare
- The physician’s office will need to call or fax your prescription to the provider you have chosen when you are in need of a refill, or for a new medication order.
- The provider will contact the physician’s office to verify the prescription as well as obtain your address, phone number and insurance information.
- The provider will then contact Mutual of Omaha to verify your benefits and eligibility.
- Lastly, the provider will contact you to re-verify your address and verify where you would like the medication delivered.
- The date of delivery of the medication will be coordinated by the provider with you and your physician’s office.
If you choose, you may "pre-enroll" with your selected Specialty Pharmacy before you would need your prescription. All you need to do is contact your selected provider and provide requested information such as your address, your phone number, your insurance information, the name of your physician, your physician’s phone number and, what medications you are currently on.