FAQ | Kroger Specialty Pharmacy (2024)

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FAQ | Kroger Specialty Pharmacy (2)

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GENERAL & REIMBURSMENT FAQ

WHAT DO I PAY FOR THESE MEDICINES?

Your benefits plan may require certain out-of-pocket costs for each supply of medicine you receive. Kroger Specialty Pharmacy thoroughly investigates your insurance benefits to ensure your claims are properly submitted.

ARE THERE ANY FINANCIAL PAYMENT PLANS?

You may qualify for financial help. A qualified specialist can help you understand if resources are available from a manufacturer program or through foundations related to your condition. We will assist you in contacting the appropriate manufacturer or foundation to apply for assistance. Based on your financial needs, the pharmacy may be able to set up a payment plan agreement for you.

DOES MEDICARE COVER MY SCRIPT?

Kroger Specialty Pharmacy does accept Medicare. In most instances Medicare does cover immunosuppressive drugs. Our dedicated teams are trained to assess each individual situation based on drug and benefit plan.

WHAT FORMS OF PAYMENT DO YOU ACCEPT?

We accept payments made by credit card, debit card, prepaid credit and debit cards and checks.

WHY SHOULD I USE KROGER SPECIALTY PHARMACY OVER MY CURRENT OR PREVIOUS PROVIDER?

Kroger Specialty Pharmacy ensures that you understand how to use your medicine and that you always have the right dose. We work closely with your doctor(s) and other caregivers to ensure that you receive the best possible care and treatments. The pharmacy can send your medicine anywhere you wish. We have a clinical team available to answer your questions 24 hours a day, 7 days a week.

HOW DO I ORDER A REFILL?

A week prior to your next refill, Kroger Specialty Pharmacy will call you to coordinate and schedule your delivery. During this call, they will also ask the following questions:


  • How are you doing with your therapy?
  • Have there been any changes to your medication?
  • Do you still take the same dose or strength?
  • Are you tolerating the medication or therapy?
  • Do you need more supplies?
  • Where would you like us to send your next refill?

HOW LONG DOES IT TAKE TO GET MY ORDER?

Kroger Specialty Pharmacy provides free, secure delivery within 48 hours after we confirm your order, or later if you request. Your medication may require a prior authorization from your insurance company which requires additional information prior to covering your medication; this may delay the initial processing of your order but you will be informed throughout the process. Your order will be validated to ensure it meets all pharmacy and insurance criteria to be covered prior to shipping. If your order is missing any information, Kroger Specialty Pharmacy may need to contact your doctor or insurance company to obtain additional information.

WHERE WILL YOU SEND MY MEDICINE AND SUPPLIES?

We deliver your order, free of charge, to your home, doctor’s office or to any other location you choose with the exception of a P.O. Box. We include all of the necessary supplies for your treatment.

HOW WILL MY MEDICINE STAY SAFE DURING DELIVERY?

Refrigerated items are packed in a plastic bag to avoid condensation. The bag is packed inside either a Styrofoam cooler or an insulated pouch. Special ice packs are included to help ensure your medicine stays cool throughout delivery. Each box is secured shut with tape.

HOW DO I TRANSFER A PRESCRIPTION TO ANOTHER PHARMACY?

Call the pharmacy and a representative will instruct you on the prescription transfer protocol. If a medication is unavailable, you will be instructed on the steps that are taken to facilitate your continuum of care.

WHAT SHOULD I DO IF I EXPERIENCE AN ADVERSE REACTION?

If you feel as though you are experiencing a life-threatening adverse reaction, call 911 immediately. If the adverse reaction is non-life-threatening you should alert both your health care professional and the pharmacy by calling and speaking with a Kroger Specialty Pharmacy clinician.

HOW DO I REPORT MEDICATION ERRORS AND PRODUCT DEFECTS?

Call the pharmacy to report any medication errors and/or product defects immediately.

WHAT SHOULD I DO IF THERE IS A DRUG RECALL?

If you have been affected by a recent drug recall, you must follow all instructions that have been provided. If you are unsure of what actions to take, contact a Kroger Specialty Pharmacy clinician to discuss.

The Kroger Specialty Pharmacy Patient’s Rights & Responsibilities document can be accessed via the link at the bottom of this page (also here). A copy was provided within the Welcome Book you received upon initiation of service with Kroger Specialty Pharmacy. You may also call the pharmacy to request another copy, if needed.

HOW CAN A PATIENT CONTACT THE PHARMACY?

We have multiple pharmacies. Please visit our Contact Us page to see full location details including phone, fax, and address.

WHAT ARE YOUR HOURS OF OPERATION?

Our hours of operation vary by location. For a complete list, please visit our Contact Us page.

HOW CAN I TRACK MY PACKAGE AND GET A DELIVERY STATUS UPDATE?

Patients have the choice to opt-in to receive email or text notifications regarding their shipping status. Patients can also call our toll-free line and speak to a representative who can provide the tracking number once the order is processed through the FedEx station in Shipping. Note to Patients: The Tracking Number will not show any information on the FedEx website until FedEx physically picks up the order and processes it into their database.

HOW CAN I OBTAIN AN ITEMIZED RECEIPT OR BREAKDOWN OF MY PRESCRIPTION?

Once a prescription is sent, a statement is created and sent to the patient. If a patient requires to have a statement out of cycle, they can call the billing/collections department at 855.733.3129 and request an updated statement.

HOW CAN I MAKE A PAYMENT?

Payments can be made by phone or mail. To make a payment by phone call 855.733.3129 and follow the prompts to select the payment by phone option. To make a payment by mail, please refer to the address provided on your statement to ensure your payment is sent to the correct pharmacy location.

RESOURCES

WHAT IF I STILL HAVE QUESTIONS?

For general inquiries, please submit your questions via our general contact form. If you have a patient-related inquiry, please submit your questions via our patient contact form. Form inquiries are answered within 48 hours of receipt. If you require immediate attention or are experiencing a medical emergency, please call 911.

FAQ | Kroger Specialty Pharmacy (2024)

FAQs

What is the profit margin on specialty pharmacy? ›

Specialty Pharmacies would love to see a 7% profit margin in specialty prescriptions but that high of a profit is only seen when the pharmacy has a preferred mail order pharmacy rate. Most independents make 1.5% to 4% on their specialty drugs.

Who is the largest specialty pharmacy? ›

The top 15 specialty pharmacies, according to 2023 revenue:
  • CVS Specialty (CVS Health) — $73.3 billion.
  • Accredo/Freedom Fertility (Cigna/Evernorth/Express Scripts) — $59.5 billion.
  • Other retail, mail, long-term care and specialty pharmacies — $37.4 billion.
Apr 16, 2024

What should you keep in mind about specialty pharmacies? ›

Specialty pharmacies must demonstrate that they have policies and procedures in place that ensure patient safety and care, strict performance measures for accuracy and demonstrate excellence in order to receive accreditation.

What should patients expect from a specialty pharmacy? ›

Generally, these pharmacies take care of prescriptions from start to finish, monitor how you are managing your diagnosis and taking your medication, communicate with you or your caregiver often, and keep in touch with your doctor to make sure things are going smoothly.

How do specialty pharmacies make money? ›

How do specialty pharmacies make money? Specialty pharmacies make money by dispensing high-cost, complex medications and providing specialized services to individuals with chronic or life-threatening conditions.

How much profit does a pharmacy make on a prescription? ›

Profitability Assessment

What should a pharmacy's gross profit margin be? For a typical retail independent pharmacy, the prescription gross profit should be at least 22%. Any lower than that, then your pharmacy is at severe financial risk. Badass Pharmacy Owners should set a goal of at least 24% (as higher is better).

Who is the richest pharmacy in USA? ›

Top 10 Pharma Companies in the US by Market Capitalization
  • Eli Lilly and Co. Pharmaceuticals and Healthcare. ...
  • Johnson & Johnson. Pharmaceuticals and Healthcare. ...
  • Merck & Co Inc. Pharmaceuticals and Healthcare. ...
  • AbbVie Inc. Pharmaceuticals and Healthcare. ...
  • Pfizer Inc. ...
  • Amgen Inc. ...
  • Bristol-Myers Squibb Co. ...
  • Vertex Pharmaceuticals Inc.

What is the outlook for specialty pharmacy? ›

Specialty drug pipeline has an expected continued growth of 8% per year through 2025. Specialty drugs may represent up to two-thirds of newly launched drugs in the next 5 years.

What drug channels are the top specialty pharmacies? ›

Despite the wide diversity of industry participants shown by the accreditation figures, the top three companies accounted for two-thirds of prescription revenues from pharmacy-dispensed specialty drugs: CVS Health, Cigna, and UnitedHealth Group.

What pharmacy specialty makes the most? ›

Here are projected earnings for the highest-paid clinical pharmacy specializations:
  • Psychiatric Pharmacists: USD 144,900.
  • Pediatric Pharmacists: USD 140,900.
  • Clinical Oncology Pharmacists: USD 142,300.
  • Ambulatory Care Pharmacists: USD 138,900.

What is the most distinctive element of a specialty pharmacy? ›

High touch: Specialty medications require extensive patient management, education and monitoring. These medications require detailed drug interaction evaluation, in-depth patient education, adherence monitoring, side effect mitigation and management, and often injection technique education.

How to start a speciality pharmacy? ›

Qualification requirements include:
  1. BSPharm or PharmD degree by an accredited college or university.
  2. No felony convictions.
  3. Current, active license in good standing.
  4. 3,000 hours of specialty pharmacy experience within 4 years.
  5. 30 hours' continuing education in specialty pharmacy within the last 2 years.

What specialty pharmacy is best? ›

Some of the top Specialty Pharmacies in the U.S. include:
  • CVS Caremark.
  • Accredo.
  • Optum Rx.
  • Walgreens Specialty Pharmacy (Alliance Rx)
  • Humana Specialty Pharmacy.
  • Prime Therapeutics (BC/BS)
Dec 5, 2022

What is so special about specialty pharmacy? ›

A specialty pharmacy provides medications used to treat rare or complex health problems. Many times, these meds aren't used by many people, so a local pharmacy wouldn't keep them in stock. These medicines may also: Need special handling by the pharmacist and you (special storage or dosage instructions, for example)

How do I choose a pharmacy specialty? ›

Specialty drugs often require extensive patient education to understand proper use, side effects, and symptoms. Choosing a Specialty Pharmacy that offers education to inform and advise patients of a medication's proper use, as well as, resources to remind and coach patients, is critical.

What is the profit margin in pharmacy business? ›

The profit margin of a retailer or pharmacy will be around 16-22% percent if the medicines are medicines. In generic medicines, it can be 20-50%. A distributor's margin is around 8 to 12 percent on branded medicines and 10 to 20 percent on generic medicines.

What is a good profit margin for pharmaceutical industry? ›

For pharmaceutical companies, the median gross profit margin was 76.5% (95% CI, 70.3%-82.7%), the median EBITDA margin was 29.4% (95% CI, 26.3%-32.5%), and the median net income margin was 13.8% (95% CI, 10.2%-17.4%).

How much profit do you get from owning pharmacy? ›

As an owner, you could earn anywhere from $400K - $700K, depending on location, and the pharmacy could profit around $4 million annually. Several factors can influence your profit, including the number of prescriptions filled, the type of services provided, overhead costs, front-end sales, and inventory costs.

What is the annual revenue of Specialty RX? ›

Specialty Rx, Inc's annual revenue is $71.8M.

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