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FAQ - Caremark Specialty Pharmacy Program
- What is the Caremark Specialty Pharmacy program?
- Effective February 15, 2006, the State Health Benefits Plan (SHBP) Prescription Drug plan has added an exclusive arrangement with Caremark for the purchase of specialty pharmaceuticals. Prescriptions for specialty pharmaceuticals will no longer be filled at retail pharmacies. All specialty pharmaceuticals can only be dispensed and purchased through the Caremark Specialty Pharmacy.
- How do I obtain my Specialty Pharmaceuticals?
- You must contact CaremarkConnect at 1-800-237-2767 to enroll in the Specialty Pharmacy program. To enroll in the program and transfer your prescription, identify yourself as a member of the State Health Benefits program and provide your prescription and doctor’s contact information to CaremarkConnect. Once enrolled in the program, CaremarkConnect will contact your doctor to obtain authorization for the specialty medication. If your doctor has any questions, the doctor may contact Horizon BCBSNJ at 1-866-776-6684.
- You must contact CaremarkConnect at 1-800-237-2767 to enroll in the Specialty Pharmacy program. To enroll in the program and transfer your prescription, identify yourself as a member of the State Health Benefits program and provide your prescription and doctor’s contact information to CaremarkConnect. Once enrolled in the program, CaremarkConnect will contact your doctor to obtain authorization for the specialty medication. If your doctor has any questions, the doctor may contact Horizon BCBSNJ at 1-866-776-6684.
- What is CaremarkConnect?
- It is a full-service mail-order specialty pharmacy dedicated to servicing members using specialty pharmaceuticals. The pharmacists are expertly trained to dispense and provide education and training for specialty oral and injectable medications. Members may contact the CaremarkConnect CareTeam 24 hours a day, 7 days a week.
- What will happen if I do not enroll in the Specialty Pharmacy program and/or obtain prior authorization for my specialty medication?
- On or after 2/15/06, if you have not enrolled in the Caremark Specialty Pharmacy program and your doctor has not been contacted by Horizon BCBSNJ to obtain prior authorization for the specialty medication, your pharmacist will receive a message indicating that the specialty medication cannot be filled at the retail pharmacy and to contact CaremarkConnect at 1-800-237-2767.
- On or after 2/15/06, if you have not enrolled in the Caremark Specialty Pharmacy program and your doctor has not been contacted by Horizon BCBSNJ to obtain prior authorization for the specialty medication, your pharmacist will receive a message indicating that the specialty medication cannot be filled at the retail pharmacy and to contact CaremarkConnect at 1-800-237-2767.
- What are dispensing limits?
- Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) monitors claims for certain drugs to ensure they are prescribed and dispensed within the proper safety standards for dosage and/or the length of time you use the drug. These standards are established from a number of sources such as Food and Drug Administration product labeling, medical literature, dispensing patterns and generally accepted standards of medical practice. Prescription quantities within the dispensing limits will be covered under your prescription drug plan.
- What happens if my specialty medication exceeds the dispensing limit?
- If your specialty medication prescription requires you to exceed the dispensing limit, you will be notified. You or your doctor can request an exception. Call 877-542-0091 to request an exception request form for your doctor to complete and fax to Horizon BCBSNJ for review.
- If your specialty medication prescription requires you to exceed the dispensing limit, you will be notified. You or your doctor can request an exception. Call 877-542-0091 to request an exception request form for your doctor to complete and fax to Horizon BCBSNJ for review.
- Must I use CaremarkConnect for all of my prescriptions?
- No, you may continue to fill your prescriptions for non-specialty medications at your retail pharmacy or through the Caremark mail order pharmacy.
