Has anyone ever heard of needing a single case agreement (SCA) for an in-network specialty pharmacy (Accredo 
) to administer a medication that has already been approved because it’s a high-cost medication? It’s billed under medical, not prescription benefits.
Since it’s in-network, a single case agreement shouldn’t even be an option, so how is this possible?
Thanks for posting! Just a reminder, if you have a medical emergency, call 911. Including your age, state, and income can help people provide better advice. Having your EOB handy is useful too.
Who told you this?
How is this medication being administered? At home by yourself or at a provider?
Is it in-network on the PBM (pharmacy benefits manager) side or in-network on the medical side?
Drew said:
Who told you this?
How is this medication being administered? At home by yourself or at a provider?
Is it in-network on the PBM (pharmacy benefits manager) side or in-network on the medical side?
The specialty pharmacy said it needs an SCA. It’s a preferred (and required) pharmacy with the insurance company and definitely in-network.
It’s administered at a provider’s office. It’s in-network on the medical insurance side, and it’s being billed under medical rather than prescription due to the cost of the medication.