The Geisinger Health Plan is taking steps to improve access, and control costs by constantly updating the Specialty Vendor Drug Program. Through a collaborative agreement with select Specialty Pharmacy Vendors, the Health Plan is able to purchase certain medications at discounted rates and pass the savings on to Members, Employers and Participating Physicians.
The Specialty Vendor Drug Program allows Participating Physicians two options: 1.) continue to "buy and bill" certain medications as usual at contracted rates, or 2.) utilize the Specialty Vendor Drug Program. Utilization of this program eliminates the need for the provider to purchase these drugs, thereby reducing out-of-pocket expenses as well as eliminating the need for submission of medication claims to the Health Plan.
Facts about the Specialty Pharmacy Drug Program Documents
- The medications included in the Vendor Program are listed in the table via the following link (see table). This table will be updated as new medications are added, or additional changes are made.
- Prescribing physicians must obtain prior authorization, when applicable (see table), and fax a completed Specialty Vendor Drug Request Form to the health plan. This allows for the physician and/or the member to acquire medications through the Specialty Vendor Drug Program.
- Upon request for prior authorization and/or the receipt of a completed Specialty Vendor Drug Request Form, the Health Plan will verify member eligibility and perform authorization review, if required. The Health Plan will notify the prescribing physicians of the approval or denial within applicable regulatory time frames.
- The Health Plan will reimburse the Pharmacy Vendor directly for the medication distributed by the Pharmacy Vendor. Participating Providers will not be reimbursed for medications obtained through the Pharmacy Vendor.
- Medication requests will be shipped according to the prescribing physician’s instructions. Please allow time for prior authorization, when applicable, as well as four (4) Business Days for delivery.
Please Note:
- Certain medications are required to be obtained through the Specialty Vendor Drug Program.
- Approved Specialty Vendor Drug Request Forms received before 4:00 p.m. Monday through Friday will be forwarded to the appropriate Pharmacy Vendor that day.
- Each Pharmacy Vendor ensures drug delivery to the location specified on the form within four (4) Business Days.
- Do not contact the Pharmacy Vendor directly to request medication included in this program.
- If the prescription indicated refills, the Pharmacy Vendor will coordinate refill delivery before the member runs out of medication.
- This list is subject to change.
Geisinger Health Plan Specialty Vendor Drug Program Quick Reference Sheet
Step 1: Is this the first time using the Pharmacy Vendor for this Member?
- Yes, and this is a new prescription, proceed to Step 2
- Yes, and this is a refill that was previously authorized by the Health Plan, proceed to Step 3
- Yes, and this is a refill for which there is not a current Health Plan authorization, proceed to Step 2
- No, and this is a refill previously authorized by the Health Plan or it does not require authorization, nothing additional is required. The Pharmacy Vendor will follow the refill instructions and deliver medication before the member runs out of medication.
Step 2: Determine if Prior authorization is required on the applicable drug?
- Refer to the above table to determine if medication in question requires prior authorization.
- If prior authorization is not required, proceed to Step 3
- If prior authorization is required, fax relevant clinical information and a completed Specialty Vendor Drug Request Form to the applicable Health Plan department. Upon prior authorization approval the prescription will be forwarded to the applicable Pharmacy Vendor. Approval or denial notification will be distributed to the requesting provider.
Step 3: Fax a completed Specialty Vendor Request Form to the Health Plan Pharmacy department at (570)-271-5610
Step 4: Upon receipt of medication, store medication in approved area and administer as prescribed.
If you have any questions regarding this program, please contact the pharmacy department at (800) 988-4861 or (570) 271-5673.
