Specialty Pharmacy

Let us file your insurance claims. We’ll contact your insurer to find out what’s covered and what paperwork they require. If a claim is denied, we try to get it approved for you or work with your doctor to find another treatment option (if available).

If you have insurance, let us know when you place your order. If we ask for information about your insurance, please respond right away. If we ask you to call your insurer, call immediately. Be sure to understand your insurance benefits and your financial responsibility.

What if I still owe something? Our team will always call you to discuss the copay when your medication is first approved or if it changes. If your copay is not affordable, our team will look for additional funding to keep your costs as low as possible. Your insurer may also send you an explanation of benefits report outlining covered services and how much they paid. Contact your pharmacy team with questions by emailing SpecialtyRX@KUMC.edu or calling 913-574-0600. We can provide the cash price of the medication upon request.

Our team will automatically look for ways to make your out-of-pocket costs as low as possible. Our team will search for copay assistance options such as copay cards, grants or free drug programs whenever possible. There are often applications to complete to obtain this funding, so our team will help you determine if you qualify and will help you complete the application. To complete the application, we may need financial records such as tax documents. Please send those as soon as requested to prevent delays.

Let us know if your insurance changes as soon as possible. Approval by your new insurer may take up to 30 days. Our team will work to get your medication approved under your new coverage. If needed, our pharmacy team will work with your provider to change your medication.

Make sure the new health plan doesn’t have a pre-existing condition clause. Or if it does, make sure it’s waived, consistent with the requirements of the 2010 Patient Protection and Affordable Care Act (ACA). Depending on the clause, it could mean that you’re without insurance or your insurance may be delayed six months or longer. For plan years beginning on or after September 23, 2010, the ACA prohibits plans from imposing pre-existing condition limits on covered persons under age 19. For plan years beginning on or after January 1, 2014, the ACA prohibits plans from imposing pre-existing limits on covered persons of any age.

Be sure to complete all forms fully and correctly. Misrepresentations of material facts can call your insurance coverage into question. Check with your insurer for details of your healthcare plan and call us with any questions before changing your plan. For Medicare plan changes, visit Medicare.gov to ensure your new plan covers your specialty medications during the annual open enrollment period.

You may be able to keep your coverage with your employer for 18 months, but you will have to pay the insurance company. This benefit is called the Consolidated Omnibus Budget Reconciliation Act (COBRA). It is a benefit you must purchase within 60 days after you stop working. Another option is to request coverage between jobs under a state program or short-term medical insurance policy. Get information on these from your human resources department. Most important, always let us know if your health benefits are going to change or have changed.

• To select those who provide you with pharmacy services
• To receive the appropriate or prescribed services in a professional manner without discrimination relative to your age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression
• To be treated with friendliness, courtesy and respect by each and every individual representing our pharmacy who provided treatment or services for you and be free from neglect or abuse, be it physical or mental
• To assist in the development and preparation of your plan of care that is designed to satisfy, as best as possible, your current needs, including management of pain
• To be provided with adequate information from which you can give your informed consent for commencement of services, the continuation of services, the transfer of services to another healthcare provider or the termination of services
• To express concerns, grievances or recommend modifications to your pharmacy in regard to services or care, without fear of discrimination or reprisal
• To request and receive complete and up-to-date information relative to your condition, treatment, alternative treatments, risk of treatment or care plans
• To receive treatment and services within the scope of your plan of care, promptly and professionally, while being fully informed as to our pharmacy’s policies, procedures and charges
• To request and receive data regarding treatment, services or costs thereof, privately and confidentially
• To be given information as it relates to the uses and disclosure of your plan of care
• To have your plan of care remain private and confidential, except as required and permitted by law
• To confidentiality and privacy of all information contained in the client/patient record and of protected health information; protected health information is shared with the patient management program only in accordance with state and federal law
• To identify the program’s staff members and their job title, and to speak with a staff member’s supervisor if requested
• To speak to a health professional
• To receive information about the patient management program
• To decline participation, revoke consent or disenrollment at any point in time

• To provide accurate and complete information regarding your past and present medical history and contact information and any changes
• To agree to a schedule of services and report any cancellation of scheduled appointments and/or treatments
• To participate in the development and updating of a plan of care
• To communicate whether you clearly comprehend the course of treatment and plan of care
• To comply with the plan of care and clinical instructions
• To accept responsibility for your actions, if refusing treatment or not complying with the prescribed treatment and services
• To respect the rights of pharmacy personnel
• To give accurate clinical and contact information and to notify the patient management program of changes in this information
• To notify the treating prescriber of their participation in the patient management program