What is a Specialty Pharmacy?
A specialty pharmacy does more than just fill prescriptions. A specialty pharmacy offers complete care for patients receiving complex medications for chronic illnesses and complicated diseases. OptiMed Specialty Pharmacy provides expert care, education, and support for our patients (through our Patient Management Programs). OptiMed works as an agent of the patient. Keep reading these Frequently Asked Questions to learn more about financial assistance or benefit support.
What are OptiMed’s Patient Management Programs?
The Patient Management Programs (PMPs) at OptiMed Specialty Pharmacy are a collection of extra services that help you get the most from your specialty medication(s). Enrolling in a PMP gives you access to many benefits to help improve your health. Examples of these benefits include refill reminder calls, education about your disease, assessments by a pharmacist to determine how well your treatment is working, tracking of your laboratory results, access to financial support, and more! Currently OptiMed has PMPs available for patients with Hepatitis C, Rheumatoid Arthritis, Ankylosing Spondylitis, Psoriasis/Psoriatic Arthritis, Crohn’s Disease, and Ulcerative Colitis. Patients with one or more of these diseases are given the opportunity to opt-in to a PMP when we receive a prescription referral. While OptiMed is able to offer a wide variety of PMP services, we are only able to do so if we have a valid prescription for your specialty medication. You can contact us at any time if you have questions about the programs.
How do I opt-out of a Patient Management Program at OptiMed Specialty Pharmacy?
The Patient Management Program at OptiMed Specialty Pharmacy includes important services designed to help you get the most from your medication(s). However, should you wish to opt-out of these extra services you can do so at any time by calling the pharmacy at 269-250-8003 or 877-385-0535. There is no penalty for opting out and you will still be able to receive your prescription from OptiMed Specialty Pharmacy. You may choose to opt back in to the program at any time.
How much do the Patient Management Program services cost? What will I owe?
The Patient Management Programs are offered by OptiMed Specialty Pharmacy at no additional cost to you! Your financial responsibilities with the pharmacy will include out-of-pocket costs such as co-payments based on your insurance benefit.
It is your responsibility to understand your insurance plan deductibles, co-pays, co-insurance, annual and lifetime co-insurance limits and changes that could occur during the enrollment period. OptiMed Specialty Pharmacy Technicians and Patient Care Advocates are available to assist in benefit investigations to help you better understand your insurance plan.
What if I cannot afford the copay for my specialty medication?
Don’t be afraid to ask to speak with one of OptiMed Specialty Pharmacy’s Patient Care Advocates (PCAs)! Our PCAs work with patients to connect them to financial support and assistance. You may be eligible for funding assistance through copay cards, manufacturer programs and/or third-party foundations. If that doesn’t work for you, our staff can work with your healthcare provider to try to find a less expensive substitute for the medication that was prescribed.
What is the best way to contact OptiMed Specialty Pharmacy?
Since we are an independently-owned organization that values patients' time, it is easy to get in touch with any department at OptiMed Specialty Pharmacy. Simply call (877)385-0535 and state the reason for your call. Our staff will promptly address your needs, or we will connect you to the correct individual who can do so. You have access to Pharmacy Technicians, Patient Care Advocates, billing and shipping personnel, and Pharmacists.
How/when will I receive the medication my physician prescribed?
OptiMed Specialty Pharmacy will contact you when your prescription is received from your doctor. You will be instructed at that time about what extra steps may be required in order to get the prescription approved through your insurance. As soon as we receive notice that the medication is covered by your insurance, we will reach out to you to schedule your delivery. You will also receive education on the medication from our Clinical Pharmacists. If the medication is not available through OptiMed Specialty Pharmacy, our staff will provide directions and information for where the product is available.
how do I find out the status of my prescription order?
When OptiMed Specialty Pharmacy receives a new prescription from your doctor, you will be contacted right away. During that call you will receive information about the prescribed medication(s) and what steps will need to be taken to get insurance approval. OptiMed will continue to work on getting insurance approval for the medication(s) until we receive notice of approval (or denial) from the insurance. At this point, we will contact you to discuss your next steps. In the meantime, if you wish to check in or ask other questions you may reach our Pharmacy Technicians at (269)250-8003 or (877)385-0535. You can also call any time you need to check the status of a refill, delivery, or with any other concerns.
What if the prescribed medication isn’t covered or is denied approval by the insurance?
Sometimes it is determined that the medication (new order or refill) will not be covered by your insurance. In this case OptiMed Specialty Pharmacists are able to assist in finding possible substitutes and consult with your physician. If denied approval, you may have the option to appeal the denial if your healthcare provider feels this is the best medication for you. OptiMed can also assist with the appeal process.
How do I place an order for a refill on my specialty medication?
As part of our Patient Management Programs, OptiMed Specialty Pharmacy offers “proactive refill management.” In other words, you don’t have to call us; we call you! A member of our team will give you a reminder call about one week prior to the next needed refill date. The refill order can be placed at this time. You may also call (269)250-8003 or (877)385-0535 at any time to place an order or check the status of a prescription. If requesting a refill, please give 48 hours advanced notice to allow for delivery/shipment.
What should I do if I lose my medication or if I need my medication early because I’m going on vacation?
It is important to always have enough of your medication available and to avoid missing doses. Most prescription insurers will allow you to obtain an early refill override for medications that are lost, stolen, or needed early for vacations. You may call your insurer to determine what exceptions are allowed by your plan. You may also contact OptiMed at (877) 232-2857 for help in assisting with this process and for guidance regarding other resources that may exist to help you get the medication you need.
Who can answer my medication-related or disease state questions?
OptiMed Specialty Pharmacy’s specially trained Pharmacists can answer medication and disease-related questions including side effect questions. You can reach an OptiMed Pharmacist by phone or in person. Call (269)250-8003 or (877)385-0535 and ask to be connected to a Pharmacist –or– visit us at 6480 Technology Avenue, Kalamazoo, MI 49009. If you need to reach your provider, you will be provided with information on how to contact them including telephone number and address.
For after-hours urgent needs, call (877) 397-0377 or (269) 501-1275 to reach our on-call Specialty Pharmacist. If it is an emergency, call 9-1-1.
Who should I contact if I have concerns with the medication when I receive it?
If you have any concerns with the state of your package when it arrives, contact OptiMed Specialty Pharmacy right away. Medications requiring refrigeration will arrive in a cooler and should feel cool to the touch upon arrival. Notify the pharmacy right away if there is a concern with the storage, contents, or condition of your medication, or if you suspected an error.
My order did not arrive as planned. What should I do?
If your order does not arrive on the date you arranged, and you have not already been notified of a delay by an OptiMed staff member, call OptiMed Specialty Pharmacy as soon as possible at (269) 250-8003 or (877) 385-0535. You will receive notification from OptiMed of any known delays in advance.
How should I dispose of unused medication?
It is important that you safely dispose of any unused medication. Follow any specific disposal instructions on the prescription drug labeling or patient information. Do not flush medication down the sink or toilet unless this information instructs you to do so. Find a medication take-back program within your community. You can contact your city or county’s trash and recycling service for options in your area.
What is the proper way to dispose of used syringes or auto-injecting pens (needles)?
Place all needles and other sharps in a sharps disposal container immediately after use. Never throw away loose needles or sharps in the trash. OptiMed Specialty Pharmacy will supply you with a sharps disposal container if your medication is injectable. Sharps disposal containers should be disposed of according to your community guidelines or other program.
Visit http://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/Sharps/UCM278782.pdf for more detailed information. The manufacturer of your medication might also offer a convenient mail-back sharps disposal program at no cost to you. Contact OptiMed Specialty Pharmacy for directions to participate in the manufacturer sharps disposal program.
How do I obtain my medication in an emergency situation or after a disaster?
It is very important that your therapy is not interrupted. If your current supply of medication is lost or needs replacement for any reason, contact OptiMed Specialty Pharmacy immediately at (269) 250-8003 or (877) 385-0535.
How will I know if I received a recalled medication?
Our staff will contact you if there has been a recall on any medication that you have received from our pharmacy. We will provide instructions for return and proper disposal of the medication, as well as steps for getting a replacement medication.
What if my insurance requires that I use a specific pharmacy?
Some insurances may allow you to fill your prescription up to three times at any pharmacy before requiring you to transfer to a mandated pharmacy. When a specific specialty pharmacy is mandated by your insurance OptiMed Specialty Pharmacy will facilitate the transfer. The prescription and any other necessary information will be given to the mandated pharmacy by telephone or fax.