Specialty medical benefit drugs
A specialty medical benefit drug is typically given as an injection or infusion in the member’s home, physician’s office, freestanding (ambulatory) infusion suite, or outpatient facility. Specialty medical drugs meet certain criteria including, but not limited to:
- The drug is used in the treatment of a rare, complex, or chronic disease
- A high level of involvement is required by a health care provider to administer the drug
- Complex storage and/or shipping requirements are necessary to maintain the drug’s stability
- The drug requires comprehensive patient monitoring and education by a health care provider regarding safety, side effects, and compliance
- Access to the drug may be limited
- Medical policy online
- Direct Ship Drug Program
- Preapproval and precertification
- Most Cost-Effective Setting Program
For more information on these drugs and conditions or specific AmeriHealth benefits information, members can log into AmeriHealth.com.
1 Drugs that are not included in this list may either not be considered specialty drugs, or may be available for coverage under the member’s pharmacy benefit. Drugs available under the pharmacy benefit are typically drugs that members can administer to themselves (e.g., oral agents, topical agents, self-injectable drugs). Benefits for pharmacy drugs offered through AmeriHealth may vary based on product line, group, or contract. Individual member benefits must be verified. For questions about coverage or specific benefits information, please go to the AmeriHealth member portal or call the telephone number on the member’s insurance card.
2 DISCLAIMER: All drugs on this list are not necessarily covered. For questions about coverage or specific benefits information, please go to the AmeriHealth member portal or call the telephone number on the member’s insurance card.