What is a Specialty Pharmaceutical?

Specialty pharmaceuticals are a group of high-cost medicines that are used to treat chronic health problems. These therapies tend to be more complicated and more costly than others. They may require special storage, regular lab testing, screening tests and may be given by injection or orally.  To get the most benefit, regular adherence to the regimen is needed. 

 

What is the Unity Specialty Pharmaceutical Program?

The Specialty Pharmaceutical Program gives high-quality clinical monitoring to patients using approved medications. The goal is to help the patients stay healthy and keep coverage of these medicines affordable.


Specialty medications must have prior authorization and must be provided by a pharmacy in the Specialty Pharmaceutical Program (UW Health and Gundersen Health System Pharmacies). Members will not be charged for shipping by standard mail. The medicine may also be picked up at the pharmacy.

 

Some examples of drug classes in this program include –

  • HIV Therapies
  • Some Oral Oncology Medications
  • Growth Hormones
  • Hepatitis C Agents
  • Multiple Sclerosis Agents
  • Biologic Response Modifiers (used for rheumatoid arthritis, Crohn's disease and others)

To see if your medication is part of the program, check the Unity Formulary. Medications included in this program are noted with an "SP."


Please note: this program does not apply to drugs given by a doctor or nurse in a clinic, hospital or other health care facility.

 

How to get your medicines from the Specialty Pharmaceutical Program –

  1. Have your doctor or nurse submit a Prior Authorization Form for your medication to Unity Pharmacy Program.
  2. If your medication is approved, call to start the enrollment process –
    • UW Health Pharmacy at 866.894.3784
    • Gundersen Health System Pharmacies at 877.208.1096
  3. Answer the questions from the pharmacy staff. They will also discuss delivery or pick-up. They will contact your doctor or nurse to get a copy of the prescription.

This program DOES NOT apply to members covered under the State of Wisconsin Health Insurance Program, who have Navitus for their drug benefit or those members with BadgerCare Plus.



Any Wisconsin pharmacy that is in Unity's participating pharmacy network and can meet the terms and conditions can participate in Unity Specialty Pharmaceutical Program. 


Pharmacies may contact the ​UW Health Pharmacy Benefit Management Program at 888.450.4884 for a copy of the terms and conditions or to apply to participate.