Specialty Pharmacy

• Specialty medicines treat complex medical conditions.
• They are administered by mouth, injection, inhalation, or infusion.
• They can be self-administered or given by a health care professional.
• Many specialty medicines need clinical monitoring.
• Specialty medicines are generally high-cost and not available at retail pharmacies.
• They often need special handling with specific delivery and storage requirements.

• The Patient Management Program is available to you at no cost and you are automatically enrolled. You can choose to opt out of this program at any time by talking directly to your Pharmacy Patient Advocate or any pharmacist.
• Enrollment in the program ensures the best outcomes from the use of your medicines.
• We provide personalized care to address your treatment plan and any problems or concerns you may have. We can also answer questions regarding your treatment such as: How drugs are used to treat your condition?; What is your medicine dose, how to take your medicine and how often?; and Possible drug interactions and how to manage side effects.
• Our goal is to help you improve your overall health and get the best possible outcomes.

Please call us at 910-715-4250, or toll-free at 855-715-7934 (option 6), or email us at specialtyrx@firsthealth.org to contact our team or to learn more about the PMP.

• Direct contact with an experienced team that will determine your insurance coverage and benefits for specialty medicines
• Refill reminders to ensure timely delivery
• Free mail order delivery of your medicine to a location and time set up by you
• Ease of access to your specialty medicines
• Education and counseling to you and/or your caregiver
• How to use and how to administer of your medicine
• Proper storage requirements
• Managing or avoiding potential side effects
• Monitoring for drug interactions
• Medication check-ups
• Communication with you and your medical provider about the care plan to ensure common goals
• Access to the Specialty Pharmacy Services Call Center. Pharmacists are on call to assist you. A Clinical Pharmacist is available for emergency consultations 24 hours a day, 7 days a week. You can call either 910-715-4250 or toll-free at 855-715-7934 then press Option 6. Your call will be routed to an on call pharmacist who will respond to you within 30 minutes

Getting started is easy. There are two options:

• Success of your medicine therapy is dependent upon active participation in our program. You must be willing to follow the directions of your provider or pharmacist. Taking medicine as instructed and discussing appropriate details of conditions related to treatment.
• Let your provider know that you enrolled in our program. We will work together to ensure the most benefit for you.
• If your contact information or insurance changes, contact us at 910-715-4250 or toll-free at 855-715-7934.

• Monday – Friday:
  • Orders take 24 hours to process
  • Prescriptions usually arrive within two to three (business) days
    • If a medication needs to be refrigerated, it will be delivered more quickly
• Next day delivery is available for urgent needs.
• We will notify you of any delays in processing time and work with you to resolve the issue. Working with your provider, we will help you find the best way to obtain your medicines.
• Some medicines need a signature for delivery. We will identify a delivery time that works in your schedule to sign for your medicine.

• We will contact you as a reminder and arrange for delivery or mail out of your medicines.
• You can choose to pick up your medicine at the pharmacy if that is more convenient.
• If you have not heard from us or you need a refill earlier than normal, you can call either 910-715-4250 or toll-free at 855-715-7934 then press Option 6.
• During regular business hours, please contact us with questions and concerns. We can help with order status, copay amounts, claims submissions and benefit coverage. You can also check on expected shipping date or report a delivery error or delay.
• A pharmacist is available 24 hours a day/7 days a week for any questions you have.

• All medicines supplied by the FirstHealth Outpatient Pharmacy come from a recognized pharmacy wholesaler or directly from the manufacturer. We maintain the highest standards of quality and patient safety.
• Pharmacists check all prescription orders. They check for interactions and allergies from the documented medicines you are taking.
• Pharmacy staff pack your medicine to protect from damage and ensure it remains at ideal temperature. Your medicine should always arrive sealed. If you suspect tampering or damage to your package, you can call either 910-715-4250 or toll-free at 855-715-7934.
• We will notify you if there is a FDA or manufacturer recall of your medicine and give instructions on what to do.

• You can pay at the FirstHealth Outpatient Pharmacy with a debit or credit card, cash, check or money order.
• If you use another method for delivery, such as mail order, you can also use a debit or credit card.
• We accept American Express, Discover, MasterCard, and Visa

• Your insurance company decides the copay amount. We will provide an estimate of your part of the cost based on your insurance or medical benefits.
• If you are unable to afford your medicine, your Pharmacy Patient Advocate may be able to find copay and patient assistance to reduce your out of pocket costs.
• Cost varies depending on the quantity of medicine dispensed. Ask your provider to prescribe the largest supply that is appropriate and covered by insurance.
• Most Medicare Part D prescription plans have a coverage gap (also called the “donut hole”). This means once you reach the coverage gap you will pay an increased cost.
• Some insurance plans need you to fill your medicine at a pharmacy other than FirstHealth Outpatient Pharmacy. We will identify these cases as soon as we receive the prescription. If your insurance requires this, we will let you know and work with your prescriber to send a prescription to the new pharmacy.
• Some medicines are under restrictions and are only carried by a few pharmacies. If this is your medicine, we will notify you and send the prescription to one of these pharmacies.

• Our team will assist you in education about your disease and management of your medicine.
• We recommend you to take and administer your medicine as ordered by your physician.
• We will develop a personalized care plan with you to manage or avoid side effects. This care plan will support the care plan that you receive from your provider.

• You can call either 910-715-4250 or toll-free at 855-715-7934 and speak to someone to initiate the transfer your prescription. We will ask you for the information we need to transfer the prescription.
• If we are unable to transfer, we will contact your provider to receive a new prescription.

• Generic medication substitution is when your provider prescribes a medicine, but the pharmacist substitutes it with the generic version. Unless your prescriber says otherwise, we will perform this to pass along cost savings to you and your copay.
• Therapeutic substitution is when your provider prescribes (brand or generic) a specific drug, but your insurance will cover a different drug in the same class. Insurance might request a generic and therapeutic substitution.
• We will work with your provider if your insurance company requires it. We will let you know once we find out about any required substitutions by your insurance. Insurance may need prior authorizations.