Specialty medications are the result of continued advances in drug development technology
and design. They are created to assist patients that are suffering from complex
disorders, chronic and/or genetic conditions which require specialized therapies
and personalized care. These advanced medications target and treat medical conditions
and include bioengineered proteins, blood-driven products and complex molecules.
Specialty medications require the prescription be filled at an in-network specialty
pharmacy as these medications:
The Specialty Drug Program addresses treatment for many complex diseases, including:
Specialty medications can be found in the Specialty Guideline Management section
of the Prior Authorization List and are classified as specialty by the notation
of SGM on the Standard and Standard with Step Therapy Formularies. The Metallic
Drug List specialty medications are indicated by placement on tier 5 or tier 6.
For more information on prior authorization requirements and network specialty pharmacies,
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