Specialty drugs

If you've been prescribed a specialty medication, you may have questions about coverage, pharmacies and next steps. We're here to help you understand your benefits and navigate the specialty prescription process with confidence.

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Understanding specialty drugs

Some specialty prescription medications require special handling, administration or monitoring. These drugs are used to treat complex, chronic and, often costly conditions. Specialty prescription coverage is based on your health plan benefits. If you're not sure whether you've been prescribed a specialty drug, you can find out by checking your drug list or logging in to myWellmark®.

Note: Depending on administration (physician-administered or self-administered), your plan will determine which benefit (medical coverage or pharmacy coverage) will cover the medication. Please call the number on the back of your Wellmark ID card to verify coverage or for clarification on your benefits.

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PrudentRx specialty drugs

The PrudentRx program helps you lower or eliminate out-of-pocket costs for certain specialty medications. Specialty medications are prescription drugs used to treat complex or chronic conditions and often require additional monitoring, support or special handling.

Coverage and participation vary by plan. Wellmark members will be contacted directly by a PrudentRx representative if they are eligible. Members can also contact Wellmark customer service to determine if they are eligible for the PrudentRx program.

How it works

Specialty drugs covered under the medical benefit (SP-M) on Wellmark’s online drug list are not eligible for PrudentRx, even if they appear on the PrudentRx drug list.

Have a question?

Call PrudentRx Monday–Friday: 7 a.m.–7 p.m. C.T. at 1-800-555-1212

Access the PrudentRx drug list

Download frequently asked questions

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Filling a specialty drug prescription

Depending on your plan’s benefits, you may be required to use a specific preferred specialty pharmacy for benefits to apply. You can find in-network specialty pharmacies using the CVS Caremark® pharmacy locator tool.

To find an in-network pharmacy:

  1. Log in to myWellmark®
  2. Select Pharmacy. This will send you to an external site with a CVS Caremark pharmacy locator tool
  3. Enter your search criteria and filter results to show specialty pharmacies only

Enrolling with a specialty pharmacy is easy. Once your health care provider submits your specialty prescription, either the pharmacy will reach out to you, or you may need to contact them directly. Your provider can let you know what to expect and whether you should call the pharmacy or wait for them to call you.

The pharmacy will thoroughly advise you on how to receive your prescription. In most cases, you can receive your specialty prescription in the mail.

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Request an early refill

If you need a refill before your next scheduled fill date, you can request an early refill for consideration. Download the form below, complete all requested details, and submit it according to the instructions included in the form.
Download refill request form
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Questions about specialty drugs
What is a specialty drug?
Specialty drugs often have unique requirements that set them apart from traditional prescription medications. They may require refrigeration, special handling, injection or infusion, close monitoring for side effects, or coordination with a specialty pharmacy and care team. They're commonly used to treat complex or long-term health conditions, such as cancer.
How to find if your drug is specialty?

You can find out if your prescription is a specialty drug by checking your drug list.

Not sure what drug list is for your plan? No problem. You can also log in to myWellmark to view your plan’s specific drug coverage details.

Do specialty drugs require prior authorization?
Some specialty medications require prior authorization before they're covered by your health plan. This process helps ensure the medication is being used safely and appropriately. Your doctor can submit the required information on your behalf.
Where can I fill a specialty prescription?
Many specialty medications must be filled through a designated specialty pharmacy. Your health plan or pharmacy benefit provider can help you determine where to fill your prescription and arrange delivery if needed.
How much will my specialty medication cost?
Your out-of-pocket cost depends on your health plan benefits, deductible, and the medication prescribed. Review your prescription drug coverage details for plan-specific information.
How do I know whether my drug is covered under my medical or pharmacy benefit?
Coverage depends on how the medication is administered. Self-administered medications are often covered under your pharmacy benefit, while medications administered by a healthcare provider may be covered under your medical benefit. Contact Member Services to verify your coverage.
What support services are available for specialty drugs?
Depending on the medication, specialty pharmacy teams may provide medication education, treatment monitoring, refill coordination, injection training, and ongoing clinical support.