Specialty pharmacy benefits

If you have a complex health condition, your provider may have prescribed a specialty medication — for example, a self-injectable or biologic. These require special handling and careful administration. That’s why we have a separate ordering process for specialty medications.

Basic information about your specialty pharmacy benefits

There are a few things to know about how to get your specialty medications:

• You’ll need to order specialty medications through Ardon Health Specialty Pharmacy.
• Ardon Health will deliver medications to your home or doctor’s office for free.
• Prescriptions may be limited to a 31-day supply and require prior authorization.
• You can see your plan’s coverage and out-of-pocket costs by clicking the “Pharmacy” tab in your Member Dashboard.

Getting started with your specialty medication

Call Ardon Health at 855-425-4085 to enroll in specialty pharmacy services. Ardon Health will contact your physician for prescription information or transfer an existing prescription from another pharmacy.

If you run out of your specialty medication before you can enroll with Ardon Health, call the Health Navigator team at 866-923-0411.

Payment and shipping

You’ll need to pay for your medication when you schedule your order.

• You can pay by credit card, debit card or check. 
• All payments must be made before the product is shipped.
• If you need financial assistance, Ardon Health can see if there are any programs available and help you apply.

Ardon Health will deliver specialty medications to your home or doctor’s office for free. 

• If your medication is refrigerated, it will be shipped via overnight delivery in special packaging to ensure it stays refrigerated.
• If your medication does not need refrigeration, it will be scheduled to arrive on the date you requested.
• Your order will include any additional supplies you need to administer your medication, such as syringes, alcohol swabs and sharps containers.

With your benefit, you can get up to a 31-day supply of most specialty medications. This helps avoid waste if a medication is discontinued. You may be able to receive up to a 90-day supply of certain specialty medications when allowed.

Your plan will not cover new specialty drugs approved by the Food and Drug Administration (FDA) until the drug is approved by Moda Health.