Prescription Process
Referral
Once we receive a referral, we will verify your demographic and insurance information, and may contact you if we need additional details. Following this benefits investigation, we will determine your eligibility for our specialty pharmacy services, complete any necessary insurance prior authorizations or appeals, and assess the need for financial assistance.
If financial support appears appropriate, our Medication Access Team will reach out to evaluate your eligibility, assist with completing applications, gather required income documentation, and submit the materials on your behalf. They will also follow up on the status and inform you once a determination has been made.
Eligibility
If an outside pharmacy is chosen to fulfill your order and you are eligible for specialty pharmacy services at Duke, our team will reach out to you to discuss the benefits of specialty pharmacy services at Duke. Otherwise, your order will be released to the appropriate in-network pharmacy of your choice.
How Long Will it Take?
When your prescription is received, the process will start that business day with the following steps:
- Benefit investigation. This typically takes a few minutes.
- Prior authorization with appeal, if necessary. Prior authorizations can take up to 3 business days, but many are completed the same day. If an appeal is needed, insurance can take up to 30 days, but many can be completed within 7 days.
- Evaluating the need for financial assistance and starting that process, if necessary. Including time for patients to return paperwork, the turnaround time can take 7-10 days.
Our commitment is to work through any of these as quickly as possible and communicate with you and your provider to keep everyone informed.
Once insurance authorizations and financial assistance are approved, we will let you know your financial responsibility and offer to ship your medication to you. After confirming shipping address and payment information, shipping will be scheduled based on our capacity and your needs. Please contact us for shipping requirements.
If your insurance does not cover the medication or you do not have insurance, and the total out-of-pocket cost does not meet your budget, we will work with your provider to select an alternative therapy.
Payment Options
For pick-up orders, we accept cash, personal check, and major credit/debit cards. For shipping, a credit or debit card is required and, with your permission only, can securely be stored in our system for future payments.
Refills
As a patient participating in our specialty medication patient management program, our team offers refill reminder calls to set up your next fill. Patients active in My Duke Health can also receive automated alerts reminding them to refill their prescription 7 days in advance. If you have not heard from us and you have 7 days or less of medication remaining, please contact us. Allowing a week to process and ship your medication will prevent disruption in your treatment due to bad weather, holiday closings, insurance changes, prescription renewals, natural disasters, or unforeseen circumstances.
Please Note - Shipping Medication
We do not automatically ship any medications. We must speak with you to verify the address and payment information each time before we ship your medication to you. Please contact us for details and mailing requirements. We are licensed to ship to the following locations:
- Connecticut
- Florida
- Georgia
- North Carolina
- Pennsylvania
- South Carolina
- Virginia
- West Virginia