Specialty Pharmacy Mandates Header

A specialty pharmacy mandate is an insurer policy that requires beneficiaries to acquire and pay for some or all medical benefit drugs through a specialty pharmacy bypassing the traditional buy-and-bill model. Once paid for in-full (generally, by the patient), the specialty pharmacy then either ships the drug to the infusion center directly ("white bagging") or ships the drug directly to the patient's home who then brings the drug to the infusion center for the appointment ("brown bagging"). Due to unknown storage and handling conditions, infusion providers generally do not accept "brown bagged" medications.

Fill out this Google Form to let NICA know how your office has been impacted.

Other Actions to Take

Instructions for customizing your letter(s):

(1) Click the blue button to download and customize your letter(s)

(2) Click “Open in Acrobat”

(3) In the menu on the right-hand side of the screen, click “Edit the PDF”

(4) Now you can fill in and customize the bold and bracketed sections of the letter(s) with your information

Use our template letter below, but make sure to personalize to fit your practice’s particular situation.

Let your patient's employer know the harm caused by benefit plans with specialty pharmacy mandates.

Download and use these talking points when talking to lawmakers. Make sure to ask what statutory protections your representatives can offer your practice as well as others in your state.

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