Specialty medication list

Specialty Drug List by Disease State
Specialty Medications on This List Require Prior Authorization
Please fax Specialty Medication Authorization Form and supporting medical records to
Delaware Physicians Care at 1-877-861-2611
• This list applies only to medications administered in a physician’s office. • Self-administered injectable medications and home infusion medications are available through the BLOOD CELL DEFICIENCY
OSTEOARTHRITIS
RESPIRATORY
GROWTH DEFICIENCY
CONDITIONS
MISCELLANEOUS SPECIALTY CONDITIONS

ATYPICAL ANTIPSYCHOTICS

INFLAMMATORY CONDITIONS
Delaware Physicians Care’s Pharmacy department wil review the request for prior authorization. If the request is approved, you wil be notified via fax. Within three (3) business days of an approval, CVSCaremark wil mail the drug directly to your office and if it is urgent, within forty-eight (48) hours of an approval. This means you wil no longer have to purchase the drug and bil Delaware Physicians Care to receive reimbursement. Delaware Physicians Care wil continue to reimburse you for the administration of drugs. Should your request for an injectable drug be denied authorization, Delaware Physicians Care wil notify you and the respective member of the outcome according to our normal denial notification process. If you have any questions, please contact Provider Note: This drug list is a guide to medications that are covered for administration in a physician’s office.
Updated 02/17/2014

Specialty Drug List by Disease State
Specialty Medications on This List Require Prior Authorization
Please fax Specialty Medication Authorization Form and supporting medical
records to Delaware Physicians Care at 1-877-861-2611
ANTIBIOTICS
MISCELLANEOUS SPECIALTY CONDITIONS

HORMONE REPLACEMENT
Depo-Testosterone (testosterone cypionate) Lupron Depot®/ Deot-PED® (leuprolide acetate)
ANTIFUNGALS

Vfend

Delaware Physicians Care’s Pharmacy department wil review the request for prior authorization. If the request is
approved, you wil be notified via fax. Within three (3) business days of an approval, CVSCaremark wil mail the drug directly to your office and if it is urgent, within forty-eight (48) hours of an approval. This means you wil no longer have to purchase the drug and bil Delaware Physicians Care to receive reimbursement. Delaware Physicians Care wil continue to reimburse you for the administration of drugs. Should your request for an injectable drug be denied authorization, Delaware Physicians Care wil notify you and the respective member of the outcome according to our normal denial notification process. If you have any questions, please contact Provider Relations at Note: This drug list is a guide to medications that are covered for administration in a physician’s office.
Updated 02/17/2014

Source: http://www.delawarephysicianscare.com/assets/pdfs/provider/specialtyPharmacy/SpecialtyMedicationList-DE_rev140117_final.pdf

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