Prescription drugs that cost more than $5,000/year are considered “specialty” drugs. These are often biologics or other prescription drugs used to treat complex conditions that have different lines of therapy, such as rheumatoid arthritis, Crohn’s disease, ulcerative colitis, multiple sclerosis and plaque psoriasis.
These specialty drugs must go through a prior authorization process before they can be approved for coverage through the Plan. In many cases, when you are prescribed a specialty medication requiring prior authorization, you will be notified at the physician’s office. Your pharmacist may also advise if authorization is required.
Prior authorization of specialty drugs is done through FACET, a program operated by the ONE-T service partner Cubic Health. Here’s how the process works:
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