Frequently Asked Questions
What is a specialty pharmacy?
The concept of a specialized pharmacy arises from the need to ensure the correct use and management of innovative, high-tech, and expensive medications, which are often known as specialty drugs.
Specialty pharmacies play an important role in the management of patients with chronic conditions whose physician has prescribed one or more medications considered specialty drugs.
The objective is for each patient to reach their therapeutic goals and avoid any problems related to the use of these medications. This objective is achieved by educating patients, giving them continuous follow-up, and anticipating possible barriers that could lead the patient to neglect the therapy, so we can provide effective solutions.
Special Care Pharmacy Services is the most experienced specialty pharmacy in Puerto Rico. Our commitment is to help patients obtain their medications as soon as possible so they can receive optimal health care and the maximum benefit from the prescribed therapy.
What services does Special Care Pharmacy Services provide and how does it help patients?
We offer the following valuable services to our patients:
- Benefits analysis, which allows the patient to have access to their medication
- Education and orientation from health care professionals with expertise in the health conditions we manage
- Financial assistance to cover the cost of your medications, if any copayment applies (if you qualify)
- Medication administration in the home
- Free specialty drug delivery around the island
Which documents do I need to send to Special Care Pharmacy Services to get my prescription processed?
- Prescription with diagnosis and indications (ICD-10 codes must be documented)
- Medical justification with previous treatments (if applicable)
- Recent laboratory tests and evidence of tests/diagnoses
- Information about your current health plan(s) and contact information
If your medication requires additional documentation, it will be requested when your prescription is evaluated.
Remember you can send your prescription and additional documentation through our web-based electronic delivery service.
What will happen if my health plan authorizes the medication(s) but I can’t cover the established copay?
At Special Care Pharmacy Services, we provide financial assistance options that will help you cover your copay, in part or in whole, if you qualify.
How long will it take to process my prescription?
When we receive your prescription, we will make sure it meets the requirements established by your health plan for the evaluation process. If additional information is needed, your case manager will contact you, the medical office, and/or the treatment center to request the necessary documents.
Our team is committed to helping you obtain your medication as soon as possible.
What will happen if I am about to finish my medication supply and my prescription included refills?
Before your next refill date, our customer service staff will contact you to check if you are ready for refill. If you are, you must authorize the pharmacy during this call so your case manager may process it.
If you are not ready torefill, an approximate date for a follow-up call will be logged in your record.
If you wish, you may also call us to request your refill.
It’s important you stay in touch with us. This way, you can keep track of how many refills your current prescription has available or if you need a new prescription for your next medication refill.
Which health plans are you currently accepting?
We accept most health plans, including the Puerto Rico Government Health Plan. This allows us to offer you our services and help you obtain your medications as efficiently as possible.
How can I send my prescription to Special Care Pharmacy Services for processing?
You may send your prescription by:
- Fax to 787-783-2951
- Toll-free to 1-855-230-9963
- Through our web-based electronic delivery service
- Email to firstname.lastname@example.org.
If your physician offers e-prescribing services, ask them to send the prescription directly to Special Care Pharmacy Services.
You may also drop off your prescription in person.
We are located at:
#55 Arzuaga Street, San Juan, PR 00925
We will gladly assist you.
The delivery technician has brought my medication. What should I do with the original prescription?
You must hand the original prescription to the technician upon receiving your medication. Your original prescription is an official document and should not be discarded, defaced, or altered.
If the prescription is at the physician’s office or treatment center, do not worry. We will receive it by other means.
What should I do if I have a complaint?
You have the right to make a claim if you have a problem or are unsatisfied with the services rendered, regarding:
- Health information disclosures
- Dissatisfaction with the services provided
All complaints will be referred to our Quality Department and will be answered within a reasonable time. To resolve a complaint, you must be willing to be interviewed. No complaint will result in delays nor will it affect the services related to your care.
Special Care Pharmacy Services guarantees total confidentiality during the follow-up process.
Click on the following link to obtain a form to log your complaints and grievances.
Process to submit a complaint or grievance:
You may file a complaint in person, by mail, by fax, by phone, or directly through our website by clicking here.
If you are not satisfied with the response to your complaint, we can schedule a meeting with all involved parties to reach a consensus that satisfies all parties.
The review of the benefits available under your health care coverage for the service requested.
One of our case managers will work with your health plan to evaluate the details of your coverage: limitations, the information needed to approve medications, duration of approval, and the patient’s responsibility (i.e., copayments or coinsurances).
Aside from this service, we also assess the need for financial assistance, if it is necessary.
This is the amount you must pay for your health care services. The coinsurance is generally expressed as a percentage. Remember to confirm with your plan whether you need to cover a deductible before the plan starts covering its share of the cost.
This is a usually fixed charge that is paid for a service. For example, if the copay for a specific medication is $50, you will need to pay $50 every time the health plan authorizes that medication. The health plan will pay for the rest of the service.
Remember to confirm with your insurance company whether you need to cover a deductible before the plan starts covering its share of the cost.
This means your health plan coverage is no longer in effect. This usually happens for one of the following reasons:
- You changed health plans: you must immediately notify the pharmacy and provide the information of the current health plan.
- You did not renew your coverage.
This is the amount of money you need to pay every year before your health plan starts covering its share of your claims. The deductible does not apply to certain services.
This is a list of medications selected by your health insurance company to which you have access as part of your drug coverage.
A formulary or basic drug list comprises the most cost-effective, safest, locally available, quality drugs that will satisfy the medical needs of most patients
This means that the medication your physician prescribed is not part of the medications included in your plan’s preferred drug list. There are exception mechanisms established by your plan to evaluate the treatment selected by your physician.
Your plan may require additional information to explain why your physician prefers that treatment as opposed to any of the options included in the drug list. Your case manager will help you, along with the personnel at your physician’s office, to obtain said information.
The information requested may include diagnosis, medical justification due to a failure of prior therapies, and/or more specific laboratory tests.
Medicare is the federal health insurance for people who are 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant; sometimes referred to as ESRD).
Advantage health plan
Medicare health plan offered by private companies under contract with Medicare.
Advantage Platinum health plan
This means that, aside from your Medicare benefits, you have coverage provided by the Puerto Rico Government Health Plan (GHP, also sometimes referred as “La Reforma” Mi Salud or Plan Vital).
Primary health plan
This is the patient’s primary health coverage (or the patient’s primary health insurance; it doesn’t necessarily include drug coverage). Check with your health insurance company if you have any questions.
Secondary health plan
This means you have a supplementary/additional coverage for your medication payments or copayments; as applicable.