Understanding your Patients' Coverage


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Unity's Specialty Pharmaceuticals Program

What is a Specialty Pharmaceutical?
Specialty pharmaceuticals are a group of self-administered medications used on a chronic basis to treat various conditions. These products often have special storage, handling and administration requirements, require patient adherence to a prescribed regimen, sometimes require laboratory monitoring, and generally cost more than $1,000 per month of therapy. Some specialty pharmaceutical medications are given by injection and others are taken orally.

What is the Unity Specialty Pharmaceutical Program?
Unity has implemented the Specialty Pharmaceutical Program to provide high-quality clinical monitoring for patients using specialty medications while keeping coverage of these products affordable.

In the program, designated specialty medications are only covered with an approved prior authorization and if obtained through a pharmacy in the Specialty Pharmceutical Program (UW Health Pharmacies or Hometown Pharmacy locations.) There are no delivery charges for standard mail. They may also be picked up.

Some examples of drug classes in this program include:

To see if your medication is part of the program, refer to the Unity Formulary. Medications included in this program are noted with an "SP." Please note: this program does not apply to medications administered in the physician's office, a hospital or other health care facility.

How to Begin Receiving a Specialty Pharmaceutical Medication

1. Have your healthcare practitioner submit a prior authorization for your medication to Unity Pharmacy Program.

2. Call one of the following two pharmacies in the Unity Specialty Pharmaceutical Program to start the enrollment process.

To find a pharmacy near you, use the online pharmacy locators:

3. Answer the pharmacy staff questions; they will then discuss delivery and pick-up options and contact your health care provider to obtain a copy of the prescription.

This program DOES NOT apply to members covered under the State of Wisconsin Health Insurance Program, who have Navitus for their drug benefit or those members with BadgerCare Plus.

Any Wisconsin pharmacy that is in Unity's participating pharmacy network and can meet the terms and conditions can participate in Unity Specialty Pharmaceutical Program. Pharmacies may contact the Unity Pharmacy Program at 888-450-4884 for a copy of the terms and conditions or to apply to participate.