PCRx Specialty Pharmacy Program

BPA will continue to utilize Point C Rx Solutions to help you obtain specialty medications.

If you are prescribed a specialty medication, you can proactively reach out to the Care Management team at (872) 265 - 4700 to get the process started or complete and return the enclosed form. Point C Rx Care Management will contact you, review the plan and gather information needed to obtain your Specialty Medication.

Please see below regarding detailed information about this program, the steps, and the necessary form to initiate the process with Point C RX Care Management.

What to expect?

If you are currently taking a specialty medication:

You will receive a call from a member of our Care Management Team
These are Registered Nurses who specialize in Care Management.
Your Care Management Nurse will gather information from you such as: Prescription medications, day-supply on hand and number of refills, prescribing physicians and medical treatment plans, diagnosis, treating physicians.
The Care Manager will review the program details with you and may require some additional personal information in order to get you started.

It can take 3 to 8 weeks to receive your medication through our program.

During this time your Care Manager will ensure that you receive your medication with no disruption.
You will not go without your medication once you are engaged in this program.
You will not miss any doses moving to this program.
While participating in this program the prescriptions obtained through this program have a $0 copay.

It is very important that you respond timely to all calls, mail, and email from your Care Manager, failure to respond timely can delay your medication delivery. Please note that your Care Manager will be reaching out to you on a regular basis. While this may seem overwhelming, the intent is to ensure that they are collecting the necessary information and keeping you informed as you transition through the process in order to help prevent any delays in obtaining your medication.

If you are prescribed a new specialty medication:

If you know your doctor prescribed a new specialty medication, you can reach out to our Care Management Team at the number or email below.
If you go to the pharmacy and your prescription is denied as "Specialty Drugs are Not Covered" or "Cost Exceeds Plan Maximum" don't be alarmed.
Our Care Managers receive daily reports for all pharmacy specialty medication rejections, they will be reaching out to you;
Or you can reach out to the Care Management Team at the number or email below.

What could members encounter during this program?

Members may be told from their Case Manager that their specialty medication is not covered. Members should not become alarmed. In order to apply for funding through Patient Assistance Programs the specialty medication must be excluded from the medical plan.
If a member does not qualify for funding under a Patient Assistance Program the drug manufacturer may generate a letter advising why the qualifications were not met. These letters vary by drug manufacturer and at times may include language inferring that it is designed primarily to assist with those less fortunate. We encourage members to not take offense to these letters, and to also understand that Point C Rx and Assembly Health have no control over these letters.
If funding through a Patient Assistance Program is not secured then the next step is to see if international sourcing through PriceMDs is possible.

What is international sourcing?

International sourcing is securing a specialty medication from outside the United States and having it shipped directly to a member's home.
Assembly Health and Point C Rx partner with PriceMDs to assist with the international sourcing process. A PriceMDs Registered Nurse will reach out to assist with navigating the process.
Medications are sourced from Europe and will be the exact medication that a member currently receives.
Most specialty medications members currently take come from European drug manufacturers.
Medications are sourced from authorized and certified drug manufacturers internationally in compliance with FDA, USDA, and CPB.
European drug manufacturers have very similar and stringent standards and requirements that the FDA enforces.
A photocopy of a current or expired U.S. or non-U.S. passport book or passport card is required for the medication to be imported into the United States.

Members that opt not to participate in the PCRx program will be responsible for the full cost of their specialty medications. Members are encouraged to participate in this program due to the cost savings that they will experience through either a PAP or international sourcing.

Specialty Pharmacy Program

International Sourcing Process