Important Specialty Pharmacy Information 

Medications handled by a specialty pharmacy often include:

• Biological medications
• Injections and infusions
• High-cost medications
• Medications that have special delivery and storage requirements, such as needing refrigeration

Below is a list of the medical conditions we dispense medications to treat. Included is contact information for you to learn more about your condition.

Personalized Care
Our pharmacists are clinically trained and experienced in your specialty medication. We will create a custom plan of care and discuss this plan with you. We will address any questions or concerns you may have at every step of treatment.

Using your medication properly can improve your treatment—so it’s important to understand and follow the directions of your doctor and pharmacist. We offer a Patient Management Program which can help you learn proper use of your medication and manage side effects.

This program provides benefits such as:

• Managing side effects
• Increasing compliance and medication adherence to drug therapy
• Overall improvement of health, provided you follow appropriate direction from the pharmacist and any other medical provider(s) directly involved in your care.

To opt-out of the Patient Management Program, you may either call the pharmacy directly or write an opt-out statement.

Collaboration with your Doctor
We will always keep the lines of communication open between you and your doctors. We are here to make sure any difficulties you experience with your treatment are addressed
immediately with your doctor.

We will need your help so that we can help you. We encourage you to actively participate in your care by responding to our outreach calls, and providing updates about your health. You need to be willing to take your medication on time and as instructed in order for it to work properly. Consultations with a pharmacist do not replace appointments with your provider.

Regular Follow-up
Getting your medications and medical supplies quickly and taking them as prescribed is very important to your care. We will stay in close contact with you during your treatment.
Always return our call as soon as possible to avoid any delays and inform us of any medication-related updates or difficulties you might be experiencing.

Explanation of Benefits
Your access to the prescribed medications is one of our highest priorities, but treatment can sometimes be costly. Our relationships with insurers will help provide you with information and explanations of your drug and medical benefits. We will help you understand your insurance coverage to bring you the most cost-effective option available.

Fast Delivery
We offer fast, free, and convenient delivery to your home, workplace or the location of your choice. A staff member will contact you before your next refill is due to coordinate your next medication delivery and update your medical and insurance records. We also offer in-pharmacy pick-up during business hours.

24/7 Support
Our specialty pharmacists are on call 24 hours a day, seven days a week for medication-related emergencies. We are always here to answer any questions or address any concerns you may have.

If you experience a medical emergency, please call 911 immediately.

If you are experiencing a non-emergent drug reaction please call our specialty pharmacist at 781-528-2600 or toll free at 833-884-3600. They are available 24/7 for medication related emergencies to address your concerns and report them to your prescriber if necessary.

In the event of a drug recall you will receive a call from a pharmacist to discuss a quick and safe resolution.

Financial Assistance and Explanation of Financial Obligations
Before your care begins, a staff member will inform you of your financial obligations that are not covered by your insurance or other third-party sources. These obligations may include, but are not limited to:

• Deductibles
• Co-pays
• Co-insurance
• Annual and lifetime co-insurance limits.

We may not be able to fill your specialty medication because some insurance plans may require you to fill your prescription at another pharmacy, or because the manufacturer limits
access to these medications. When this happens, we will notify you and work with your provider to transfer the prescription(s) to the correct pharmacy.

As our patient, you will have access to financial assistance programs to help with copayments should you be unable to afford your medication. These programs include discount coupons from drug manufacturers, co-payment vouchers, and assistance from various charitable organizations and pharmaceutical companies. Please let us know if you need financial assistance.

Order Delays
Should there be a delay in filling or delivering your prescription, we will notify you to limit any interruptions in your therapy. If our pharmacy is unable to provide your medication, we will help you get your medication from another pharmacy.

Please call the pharmacy directly in the event that your medication has not arrived as scheduled so that we can investigate the delay.

Insurance Assistance
BIDMC Specialty Pharmacy works closely with your doctor and insurance company to submit any prior authorizations that are required. We also work with manufacturers and assistance programs for patients who need additional financial coverage. Our goal is to ensure that coverage does not become a barrier to patient care.

We work with most major insurance companies. Staff will submit claims to your health insurance carrier on the date your prescription is filled.

Co-payment Collection
We are required to collect all co-payments prior to shipment of your medication. Co-payments can be paid by credit card (Visa, MasterCard, AMEX and Discover) over the phone and by check or money order through the mail.

Important Insurance Terms to Know
All prescription insurance companies have different kinds of plans. To help you understand your benefits, here are some common terms and their meanings:

Refill-too-soon: You are trying to refill a prescription sooner than your insurance company approves. Most insurance companies allow you to refill a prescription once a certain amount of your medication is used. This is based off the anticipated amount of days your supply should last. If your dose has increased or you are going on vacation, please contact us immediately at 781-528-2600.

Quantity Limits: Your provider has written for a certain amount of medication, but it is more than your insurance will cover. This can be limited to tablets per day or by how many months of medication you can receive at a time. Pharmacy staff will explain this and work with you to answer any questions or concerns

Step Therapy: Your insurance plan wants you to try other less expensive medicines, or “steps”, before they will pay for the prescribed medication.

Prior Authorization: The medication being prescribed is not covered by your plan without supporting information such as medications tried and failed. The BIDMC Specialty Pharmacy will work with your provider’s office to get this authorization, and we will keep you updated throughout the process.

Copayment: Depending on your insurance plan it is either a fixed or variable payment for a covered service made each time you receive this service. An example of such a service is filling a prescription.

BIDMC Specialty Pharmacy supports your right to know about your health and illness, and your right to participate in decisions that affect your well-being. Our own statement of patients’ rights, incorporating state and federal law, describes our commitment to protecting your rights.

Patient Rights

• You have the right to choose who provides you with pharmacy services and to choose an attending physician, if applicable.
• You have the right to receive proper and professional pharmacy care in accordance with physician orders free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse without discrimination against your race, sex, color, religion, sexual orientation, disability, gender identity, immigration status, or age.
• You have the right to be treated with dignity and individuality, including respect for your autonomy, property, and right to confidentiality in treatment.
• You have the right to take part in developing and/or changing your plan of care, as well as receiving the needed information to take part in your care, including the proper use, handling, and storage of your medications and its effects.
• You have the right to be provided with adequate information with which you can give your informed consent for the start, continuation, or termination of services, as well as transfer of services to another health care provider.
• You have the right to voice grievances/complaints and/or suggest changes in your pharmacy care/services including recommending changes in policy or personnel, without compromising your care/services or causing any type of repercussions. To have any grievance/complaint regarding treatment or care (or lack thereof) furnished, or lack of respect of property promptly investigated and be notified of the findings and/or corrective action taken.
• You have the right to request and receive complete and up-to-date information relative to your condition, treatment, alternative treatments, and risk of treatment or care plans.
• You have the right to receive treatment and services within the scope of your plan of care, promptly and professionally, while being fully informed as to our policies, procedures and charges.
• You have the right to request and receive data regarding treatment, services, or costs, privately and confidentially.
• You have the right to be given information as it relates to the uses and disclosure of your plan of care.
• You have the right to receive instructions on handling drug recalls.
• You have the right to confidentiality and privacy of all information contained in the client/ patient record and of Protected Health Information; PHI will only be shared with the Patient Management Program in accordance with state and federal law.
• You have the right to receive information on how to access support from consumer advocates groups.
• You have the right to identify our staff members including their job title, and speak with a supervisor at any time if requested.
• You have the right to speak to a health care professional.
• You have the right to receive information about the Patient Management Program, including changes in or termination of the Patient Management Program.
• You have the right to decline participation, revoke consent or dis-enroll at any point in time.
• You have the right to be informed in advance of the care being provided, as well as the charges, including payment for care/service expected from third parties and any charges for which the client/patient will be responsible.
• You have the right to receive information about the scope of services that we can provide and any limitations on those services.
• You have the right to participate in the development and periodic revision of the plan of care.
• You have the right to refuse treatment at any time and be informed of potential consequences of refusing treatment.
• You have the right to be informed of client/patient rights under state law and to formulate an Advanced Directive, if applicable.
• You have the right to be able to identify visiting personnel members through proper identification.
• You have the right to be advised on pharmacies’ policies and procedures regarding the disclosure of clinical records.
• You have the right to be informed of any financial benefits when referred to an organization.
• You have the right to be fully informed of one’s responsibilities.

Patient Responsibilities
To ensure you receive the best pharmacy care possible from BIDMC Specialty Pharmacy, we ask that you accept the responsibility to:

• Provide accurate and complete information regarding your past and present medical history and contact information including any changes.
• Agree to a schedule of services and report any cancellation of scheduled appointments and/or treatments.
• Participate in the development and updating of a plan of care.
• Communicate whether you clearly understand the course of treatment and plan of care.
• Comply with the plan of care and clinical instructions.
• Accept responsibility for your actions, if refusing treatment or not following with the prescribed treatment and services.
• Respect the rights of pharmacy personnel.
• Notify your treating physician of participation in the services provided by the pharmacy and to notify the pharmacy with any potential side effects and/or complications.
• Notify BIDMC Specialty Pharmacy via telephone when medication supply is running low so that a refill may be shipped to you promptly.
• Submit any forms necessary to participate in the program to the extent required by law.
• Maintain any equipment provided.
• Notify the pharmacy regarding any concerns about the care or services provided.

Should you have concerns, problems, or complaints about the quality of care or service that you are receiving, you are encouraged to speak to the providers directly involved in your care. BIDMC Specialty Pharmacy believes that all patients have the right to be heard, to report a grievance, to have those grievances acknowledged, and to be provided with a written response of the resolution.

What is a Grievance?
Grievances are complaints about the way BIDMC Specialty Pharmacy is providing care or the way a staff member has treated you or behaved towards you. A grievance is not the way to deal with a complaint about a treatment decision or service that is not covered.

How to File a Grievance
Contact the BIDMC Specialty Pharmacy Customer Service Department at 1-833-884-3600.

All grievances will be documented and forwarded to the Compliance Manager. Within three (3) business days of receiving a complaint, BIDMC Specialty Pharmacy will respond to you using either oral, telephone, email, fax, or letter format, that we have received the complaint and that we are investigating. Within five (5) business days, BIDMC Specialty Pharmacy will provide you with verbal notification as to the nature of the complaint, results of our investigation, steps taken by the organization to resolve the complaint and our response to the complaint. Similar written notice will be provided upon request.

If you find the above avenues unsatisfactory, or you may contact any of the following agencies:

ACHC Complaint Information
General Phone Number: 855-937-2242

Joint Commission Complaint Information
General Phone Number: 630-792-5800

URAC Complaint Information
Email: grievances@urac.org
General Phone Number: 202-216-9010

You may also file a complaint with the Massachusetts State Board of Pharmacy.

Additional Information About Your Rights as a Patient

Offer to Counsel
You have the right to know about the proper use of your medication and its effects. If you need more information, please ask the pharmacist.

No Automatic Refill Policy
BIDMC Specialty Pharmacy cannot refill prescriptions without your verbal or written request. This policy is in compliance with insurance rules and regulations, and applies to all patients regardless of insurance carrier. Because taking your medication as directed is an important part of your treatment, we attempt to call all patients who are due for medications as a reminder. In the event of a missed call, it is up to you, the patient, (or caregiver) to call the pharmacy to authorize a refill.

Adverse Effects to Medication
If you are experiencing adverse effects to the medication, please contact your doctor or your pharmacist at BIDMC Specialty Pharmacy.

Drug Substitution Protocols
Unless otherwise indicated, all prescriptions will be filled with an FDA-approved generic medication if one is available per Massachusetts State Law.

Protecting Your Privacy
BIDMC Specialty Pharmacy will protect the privacy of your health information as required by federal and state laws, regulations, and other authorities and to keep you informed of your rights. Our pharmacy personnel are committed to protecting the confidentiality of your protected health information (PHI) and will only disclose your PHI to a person other than you or your personal representative when permitted under federal or state law.

Our privacy policy describes our information collection practices and informs you about how we use that information. It also includes a description of the choices you can make about the way your information is collected and used. For a complete copy of our Notice of Privacy Practices, call 781-528-2600 or toll free at 1-833-884-3600. Beth Israel Deaconess Medical Center’s Notice of Privacy Practices can be found here.