Specialty Pharmacy
East Tennessee Children’s Hospital Specialty Pharmacy serves patients within the State of Tennessee who are taking specialty medications. Once we receive approval from your insurance provider to dispense your child’s medication, your child will be enrolled in our specialty pharmacy service.
As a Specialty Pharmacy patient, your family will have access to many different services, including:
- Support 24 hours a day, 365 days a year, including national holidays.
- Individual treatment and personalized programs that are developed with you and your child's doctor and tailored to your child's specific condition.
- Ongoing education regarding your child's specialty medication in clinic settings, over the phone and patient education materials including drug education handouts.
- Ensured monthly delivery of refills and expert managing of all details for medication shipping and delivery.
Patient Management Program
As a patient of our specialty pharmacy, we will keep watch over your medications and your overall progress through our patient management program. This program will help you manage side effects, increase your ability to stay on your drug therapy and improve your overall health. A limitation of the program is that you must be willing to follow the treatment plan your care team created. On a regular basis, we will review:
- Current medications you are on and if they are still right for you
- Any side effects you are experiencing
- Your response to therapy
- Your ability to stay on therapy
This service is provided to your family at no additional cost and enrollment is optional. You may contact us at any time to be removed from this service.
How to Fill a New Prescription
We will work with your child’s prescriber when a new medication is needed. In many cases, your child’s prescriber will electronically send the prescription to the specialty pharmacy. However, you may also reach out to the Children’s Hospital Specialty Pharmacy to obtain a new prescription directly from your child’s provider.
Insurance
Children’s Hospital Specialty Pharmacy Staff will work with your child’s physician and your insurance company to get your child’s specialty prescription covered. This process is called prior authorization. While prior authorization may often take a few business days to complete, our team will be sure to keep you and your child’s doctor informed of each step of the process. We will send insurance claims to your insurance on the date your prescription is filled.
Appeals
If your insurance denies coverage for your child’s medication, you may have the right to file an appeal with your health plan. Our specialty pharmacy team has the knowledge and resources available to help you with the appeals process.
Medications not available at the Specialty Pharmacy
If the Children’s Hospital Specialty Pharmacy is unable to provide your child’s specialty medication, we will work with you and an appropriate pharmacy to ensure you receive your child’s medicine. If you would like your child’s prescription transferred to another pharmacy, please contact the pharmacy to transfer the prescription on your behalf.
Refill Reminders
You will receive a courtesy call from the Children’s Hospital Specialty Pharmacy about a week before your child’s next refill is due. At this time, we will confirm that your child is still taking the medication, verify shipping address, and connect you with a clinical pharmacist if you have any questions or concerns about your child’s treatment. You may also order refills yourself by:
Financial Assistance
Medication can be expensive, even after insurance pays most of the cost. If you cannot afford your copay, Children’s Hospital Specialty Pharmacy staff will research available financial assistance programs to help reduce your out-of-pocket expense. The specialty pharmacy works with a number of foundations and manufacturer programs that provide financial assistance for specialty medications.
Prescription Delivery
We will contact you to determine how you would like to receive your child’s specialty medication. We can coordinate free delivery to your home, your doctor’s office or an approved alternate location.
If you choose to have your child’s medication delivered, the Specialty Pharmacy will ship securely. If you cannot be there to accept the package, we can arrange for it to be left at your home or at another approved location. If you feel your child’s medication has not been maintained at the manufacturer’s recommended temperature, please contact the Children’s Hospital Specialty Pharmacy immediately.
Order Status
Check the status of your order by calling and speaking to our staff at 865-541-8491 or toll free at 833-625-1948.
Drug Recalls
If your medication must be sent back for any reason, the Children’s Hospital Specialty Pharmacy will contact you with instructions that have been given by the Food & Drug Administration (FDA) or drug manufacturer.
Drug Changes
Sometimes generic drugs need to take the place of brand name drugs. This can happen if your insurance company wants you to use the generic drug or it may be done to lower your co-pay. If this change needs to be made, a member of our staff will contact you before shipping your medication.
Payment Policy
- Copayments: You may have to pay part of your medication cost called a copayment. This must be paid at the time of pickup or shipment. We accept all major credit cards.
- Financial Assistance: We will help enroll you in assistance programs to help with copayments and make sure there are no financial barriers to starting your medication. These programs include discount programs from drug manufacturers and assistance from various disease management foundations.
Frequently Asked Questions
What is a Specialty Pharmacy?
A specialty pharmacy dispenses specialty medications. Specialty medications are expensive drugs used to treat complex, chronic conditions. They often require special handling and/or administration, and may not be available at your local pharmacy. Sometimes these medications require special teaching and monitoring by a trained pharmacist. We focus on providing these medications while offering the knowledge, support, service and care needed to get the most out of your child’s specialty drug therapy.
Does the Specialty Pharmacy has access to all specialty medication?
The Children’s Hospital Specialty Pharmacy has access to many specialty medications. If we do not have access, we will transfer your child’s prescription to a pharmacy that does.
When should I contact the Specialty Pharmacy team?
- When you have any questions or concerns about your child’s medication
- When you suspect your child is having a reaction or allergy to their medication
- When a change has occurred in your child’s medication use
- When your child’s medication list has changed — if your child starts or stops medicines or if your child’s dose changes
- When your address or telephone number has changed
- When your insurance information or payment source has changed
- When you need to reschedule or check the status of your delivery
- When you suspect a dispensing or shipping error has occurred
- When you have any questions or concerns about our specialty pharmacy service
How much will my medication cost?
Your out-of-pocket cost will vary based on your insurance plan. Children’s Hospital Specialty Pharmacy staff will tell you the amount owed after processing your child’s prescription.
What if I can’t afford my medicine?
Our pharmacy team has knowledge of and access to many financial assistance programs. These include manufacturer discount coupons, disease management foundations, and charities. If you are eligible, we will help enroll you in these programs.
What should I do if my child has a bad reaction to the medication?
Call 911 or bring your child to the Children’s Hospital Emergency Department if the reaction is serious or life-threatening. Contact your child’s physician and pharmacy staff to report the reaction.
