What is a Specialty Pharmacy?
A specialty pharmacy does more than fill prescriptions. A specialty pharmacy offers complete care for patients receiving complex medications for chronic illnesses and complicated diseases. We provide expert care, education, and support for our patients through our Patient Management Programs. OptiMed works as an agent of the patient to help navigate the treatment journey and ensure the best patient experience.
What are OptiMed’s Patient Management Programs?
Our Patient Management Programs (PMPs) are a collection of extra services that help you get the most from your medication(s). Enrolling in a PMP gives you access to benefits to help improve your health such as refill and appointment reminder calls, education about your disease, assessments by a pharmacist to determine how well your treatment is working, tracking of your laboratory results, access to financial support, and more! Patients are given the opportunity to opt-in to a PMP when we receive a prescription referral. While we offer a wide variety of PMP services, there are a few limitations. We are only able to offer PMP services to patients with a valid prescription. Additionally, some PMP services require the patient to provide additional information about your health. Without your active participation, some services may not be available. You can contact us any time if you have questions about the programs.
How do I opt-out of a Patient Management Program?
The PMPs include essential services designed to help you get the most from your medication(s). However, should you wish to opt out of these extra services, you can do so anytime by calling OptiMed at (877) 232-2857. There is no penalty, and you’ll still be able to receive care from OptiMed. In addition, you may opt back into the program at any time.
How much do the Patient Management Program services cost? What will I owe?
The PMPs are a complimentary service offered at no additional cost to you! Your financial responsibilities will include out-of-pocket medication or nursing services costs, such as co-payments based on your insurance benefit. In addition, you are responsible for understanding your insurance plan deductibles, co-pays, co-insurance, annual and lifetime co-insurance limits, and changes that could occur during the enrollment period. Our staff can assist with benefit investigations to help you better understand your insurance plan.
What is the best way to contact OptiMed?
Since we are an independently owned organization, it is easy to contact us by calling (877) 232-2857. Our staff will promptly address your needs, or we will connect you to the correct individual who can do so. In addition, you have access to nursing staff, pharmacy technicians, patient care advocates, billing and shipping personnel, and clinical pharmacists.
Who can answer my medication-related or disease state questions?
OptiMed’s specialty-trained clinical pharmacists and nurses can answer medication and disease-related questions, including side effect questions. In addition, you can reach an OptiMed clinician by phone or in person. Call (877) 232-2857 and ask to be connected to a clinician. If your inquiry requires input from your referring provider, our team will coordinate care. It can also provide the information needed to contact your provider directly.
If there’s an emergency, call 9 1 1.
Call (877) 397-0377 for urgent after-hours needs to reach our on-call Specialty Pharmacist.
What if I cannot afford the copay for my specialty medication?
Our Patient Care Advocates (PCAs) work with patients to connect them to financial support and assistance. You may be eligible for funding assistance through co-pay cards, manufacturer programs, and third-party foundations. If that doesn’t work, our staff can work with your provider to find a cheaper substitute for the prescribed medication or treatment.
What if the prescribed medication isn’t covered or is denied approval by the insurance?
Sometimes medication will not be covered by your insurance. In this case, OptiMed pharmacists assist in finding possible substitutes and consult with your provider. If denied approval, you may be able to appeal the denial if your provider feels this is the best medication for you. OptiMed can also assist with the appeal process.
How do I obtain my medication in an emergency situation or after a disaster?
It is vital that your therapy is not interrupted. If your current supply of medication is lost or needs a replacement for any reason, contact us immediately at (877) 232-2857. If a disaster prohibits OptiMed from safely conducting business, arrangements will be made to establish an alternative care site for patients needing emergent treatments.
What should I do if I lose my medication or if I need my medication early because I’m going on vacation?
You must have sufficient quantities of all your medications available. Most prescription insurers will allow you to obtain an early refill override for medications that are lost, stolen, or needed early for vacations. You may call your insurer to determine what exceptions your plan allows. You may also contact OptiMed at (877) 232-2857 for help assisting with this process and for guidance regarding other resources to help you get the medication you need.
I am a specialty pharmacy patient not requiring nursing or infusion care. How/when will I receive medication my provider prescribed?
OptiMed will contact you when we receive your prescription from your provider. You’ll be instructed then about what extra steps may be required to get the prescription approved through your insurance. We will contact you to schedule delivery as soon as we receive notice that your insurance covers the medication. You will also receive education on the medication from our clinical pharmacists. If the medication is unavailable through OptiMed, our staff will provide directions and information on where the product is available.
How do I find out the status of my prescription order?
You will be immediately contacted when OptiMed receives a new specialty prescription from your provider. During that call, you will receive information about the prescribed medication(s) and the steps needed to get insurance approval. OptiMed will continue to work on getting insurance approval for the medication(s) until we receive notice of acceptance (or denial) from the insurance. At this point, we will contact you to discuss your next steps. In the meantime, if you wish to check in or ask other questions, you may reach our staff at (877) 232-2857. You can also call anytime you need to check the status of a refill, delivery, or any other concerns.
How do I place an order for a refill on my specialty medication?
OptiMed offers “pro-active refill management” as part of our PMPs. We will give you a reminder call about one week before the next needed refill date. The refill order can be placed at this time. You may also call us at (877) 232-2857 at any time to place an order or check the status of a prescription. If requesting a refill, please give 48 hours advanced notice to allow delivery.
How will I know if I received a recalled medication?
OptiMed will contact you if there has been a recall on a medication you received from our pharmacy and provide instructions for a return and proper disposal of the drug, as well as steps for getting a replacement medication.
What if my insurance requires that I use a specific specialty pharmacy? Or the medication is not available at OptiMed?
Some insurances may allow you to fill your prescription up to three times at any pharmacy before requiring you to transfer to a mandated pharmacy. When your insurance mandates a specific specialty pharmacy, OptiMed will facilitate the transfer. For medications that are unavailable through OptiMed, our care team will find an alternate pharmacy that can service you. The prescription and any other necessary information will be given to the mandated/alternate pharmacy by telephone or fax, and we will notify you and your provider of the change.
Who should I contact if I have concerns when I receive my specialty medication?
Medications requiring refrigeration will arrive in a cooler and should feel cool to the touch. Notify the pharmacy immediately if there is a concern with your medication's storage, contents, or condition or if you suspect an error.
My order did not arrive as planned. What should I do?
If your order does not arrive on the date you arranged, and you have not been notified of a delay by an OptiMed staff member, call us as soon as possible at (877) 232-2857. You will receive notification from OptiMed of any known delays in advance.
How should I dispose of unused medication?
It is important that you safely dispose of any unused medication. Follow specific disposal instructions on the prescription drug label or patient information. Medication should not be flushed down the sink or toilet. Many communities offer medication take-back programs, and you can contact your city or county’s trash and recycling service for options in your area.
What is the proper way to dispose of used syringes or auto-injecting pens (needles)?
OptiMed will supply you with a sharps disposal container if you receive injectable medication. Place all needles and other sharps in a sharps disposal container immediately after use. Never throw away loose needles or sharps in the trash. Sharps disposal containers should be disposed of according to your community guidelines or other programs.
The manufacturer of your medication might also offer a convenient mail-back sharps disposal program at no cost. Contact us for directions to participate in the manufacturer sharps disposal program.
How To Contact Us
If you have questions about our Privacy Policy, contact us by:
Phone: 877.232.2857
E-mail: Click here
Mail:
OptiMed Health Partners
Attn: Privacy Officer
6480 Technology Avenue, Suite A
Kalamazoo, MI 49009
Effective and last updated: 06/02/2023.
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