Frequently Asked Questions
The concept of specialty pharmacies originated from the need for the correct use and management of new, technologically-advanced and high-cost medications, which are commonly called specialty medicines. The specialty pharmacy plays an important role in the management of pharmacological therapy of patients with chronic conditions, to whom their doctor has prescribed one or more medications known as “specialty drugs”.
The objective of specialty pharmacies is achieving each patient’s therapeutic goals and avoiding problems related to the use of these drugs. These goals are achieved through educating and continuously monitoring the patient, as well as anticipating any possible barriers that may lead the patient to discontinue treatment, so that we may assertively provide solutions.
Special Care Pharmacy Services is the most experienced specialty pharmacy in Puerto Rico. We are committed to helping patients obtain their medication as soon as possible, so they may receive optimal health care and the maximum benefit from the prescribed treatment.
We offer the following valuable services to our patients:
- Benefits analysis that allows the patient to access his or her medication
- Education and orientation from health care professionals specialized in the conditions we provide care for
- Financial Assistance if a copayment is applicable (if the patient qualifies)
- Home medication management
- Free delivery of specialized medicines to the entire island
- Prescription with diagnosis and indications (ICD-10 codes must be documented)
- Medical justification with prior treatments (if applies)
- Recent lab results and diagnostic tests/studies
- Current health plan(s) information and contact information (address and telephone numbers)
If your prescription requires additional documents, they will be requested upon evaluation of your prescription.
Remember that you may send us your prescriptions and supporting documents through our electronic web service.
At Special Care Pharmacy Services we offer financial aid alternatives that will help you cover – in whole or in part – the copay, if you qualify.
Patients must meet eligibility requirements, which vary depending on the type of the funds. We help patients through the qualification process.
As soon as your prescription is received, we will verify that it meets the requirements established by your health insurance plan for the evaluation process. If additional information is needed, your case manager will contact you and/or the medical office or treatment center, to request the necessary documents.
Our team is committed to helping you get your medication as soon as possible.
Our customer service staff will contact you to verify if you need a refill. If a refill is needed, you must authorize the pharmacy over the phone, so your case manager can process it. If you don’t need a refill, we will contact you at a later date to check again.
Also, you can always contact us to request a refill.
It is important that you stay in touch with us and are aware of the number of refills available on your current prescription, or if a new prescription will be required for your next supplement.
We accept most health insurance plans; including the Government’s Health Plan (Plan de Salud del Gobierno). This allows us to provide our services by helping you access your medications.
- You may send it via fax: 787-783-2951 or toll free to: 1-855-230-9963
- You may send it directly through our electronic web service.
- You may send it via e-mail: firstname.lastname@example.org
- If your doctor offers e-prescribing, you may request that he send the prescription directly to Special Care Pharmacy Services.
- You may also bring it in personally to:
We will be glad to assist you.
9- The delivery technician brought me my medication. What should I do with the original prescription?
You should hand the original prescription to the technician when he delivers your medication. The original prescription is an official document and should not be discarded, mutilated or altered.
Don’t worry if the medical office or treatment center has the original prescription. We will go through a different process to obtain it.
You have the right to file a complaint if you have a problem or are dissatisfied with services provided regarding:
- Disclosure of health information
- Dissatisfaction with services provided
All complaints will be referred to the Quality Department and will be answered within a reasonable time. To resolve the complaint you must be willing to be interviewed. Complaining will not cause delays, nor affect services related to your care.
Special Care Pharmacy Services guarantees complete confidentiality during the follow-up process.
Click on the following link to download the Complaint and Claim Form.
Process to submit a complaint or claim:
Complaints may be filed in person, by mail, by fax, by phone, or clicking here.
If you are not satisfied with the response offered to your complaint, we can arrange a meeting with the involved parties to explore a consensus that satisfies all parties.
Verification of all benefits available to the patient under his/her healthcare plan coverage for the requested services.
One of our case managers will verify all of the details with your healthcare plan; limits, additional information required for medication approvals, approval duration, and patient obligations (copayments and/or coinsurance).
Additional to this service, support is provided when financial assistance is needed.
This is the amount you must pay for your medical care. Coinsurance is generally expressed as a percentage.
Remember to confirm with your plan if you must cover a deductible before the plan begins to cover part of the cost.
This is a charge that is usually fixed and is paid to use a service. For example, if a $50 copayment is indicated for a specific drug, you must pay $50 each time the healthcare plan gives authorization for that drug. The healthcare plan will pay for the rest of the service.
Remember to check with your insurance if you must cover a deductible before the plan begins to cover part of the cost.
This is the amount of money you must pay each year before your health plan begins to cover part of your claims. For some services, no deductible is applicable.
A list of medications that your health insurance company selects and to which you have access as part of your prescription plan.
A formulary list (or list of essential drugs) that includes the most cost-effective, safest, locally available and quality-assured drugs to meet the health care needs of most patients;
Means that your healthcare plan coverage is no longer active. This generally occurs due to the following reasons:
- You changed your healthcare plan – you must immediately notify the pharmacy and provide current health plan information.
- You did not renew your healthcare coverage.
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
Means that the medication your doctor prescribed is not part of the medications included in your insurance’s preferred drug formulary. There are mechanisms established by your healthcare plan to evaluate the treatment selected by your doctor.
Your insurance may require additional information explaining why your physician prefers this treatment and not one of the alternatives included in your drug formulary. Your case manager would assist you along with the staff from your physician’s office to obtain this information.
Some of these are the diagnosis, medical justification due to the failure of previous therapies and/or more specific laboratories.
Is the patient’s main health coverage (or the patient’s primary health insurance coverage – does not always include drug coverage – consult your health insurance company if you have questions).
Means you have a complementary / additional insurance to cover your medications or copayments; as applicable.
A Medicare health plan offered by a private company that has a contract with Medicare.
Means that in addition to your Medicare benefits you have coverage provided by the Government Health Plan (PSG previously known as La Reforma o Mi Salud).