ALERT! Diplomat, the plan's network specialty pharmacy, is unable to ship outside the United States. See travel overrides for prescription drugs if you will be traveling.

"Specialty" drugs are high-cost injectable, infused, oral, or inhaled drugs that generally require special handling (including a few products, such as intrauterine devices [IUDs]). Specialty drugs are subject to special rules. You can find out if a drug is a specialty drug by checking the UMP Preferred Drug List, or by calling Washington State Rx Services. Specialty drugs are covered under the cost-share tier listed on the UMP Preferred Drug List.

You may receive up to a 30-day supply for specialty medications per prescription or refill. Specialty drugs are covered only when purchased through the plan's network specialty drug pharmacy. Select specialty medications that have been determined to have a high discontinuation rate or short duration of use may be limited to a 15-day supply. Order your specialty medications from Diplomat Specialty Pharmacy at 1-877-203-8602 (hours are Monday-Friday 6 am to 8 pm Pacific Time, and Saturday 6 am to 2 pm).

Specialty drugs require preauthorization. A Patient Care Coordinator will contact your provider to review the coverage criteria and authorize the prescription if the criteria are met. The Patient Care Coordinator will work with you to schedule a delivery time for the medication. If you are unable to be present for the delivery, the specialty pharmacy will deliver your medications anywhere you choose, such as to your workplace or to a neighbor, but not out of the country. Specialty medications often require special handling and storage, so someone must be present to sign for them.

If your provider will be administering a medication, you can have it shipped to the provider's office. However, once the drug is received at the provider's office, the provider takes responsibility for the drug.

See also:  Prescription Cost-Limit for Specialty Drugs