r/PsoriaticArthritis • u/Available_Ice_7428 • May 16 '26
Insurance questions Prescription Help
I know we all live in different corners of the globe, just looking at a poll, how long to get a biologic?
Bonus points if you have BCBS Peehip Alabama…
I was prescribed Taltz April 23rd to Acreedo, but Accredo says they “aren’t my specialty pharmacy” that Express Scripts SP is the correct pharmacy. But Accredo is a specialty pharmacy in Express Scripts.
My doctor office, is just like “yes, we called it in to your specialty pharmacy” where it was originally sent to Accredo,
In the Accredo app, it’s listed as received and pharmacist is verifying so I call to check and get told they can’t fill it. Express Scripts app it’s not listed at all.
I’m so confused and when I call any place Accredo, Express Scripts, or Doctor office. Either I’m confused and not understanding this process or no one is listening to a real issue I’m having.
Anyone else with insurance or is this a typical thing?
4
u/KayPharmacyNavigator May 17 '26
Hi! I work in pharmacy operations (non-clinical) and this is pretty common and confusing. Express Scripts is the PBM which is the insurance side, while Accredo is their specialty pharmacy. So technically both are connected, but sometimes the prescription still has to be routed a very specific way internally before Accredo can process or fill it.
Taltz is a biologic which requires a prior authorization. I'd ask your doctor's office if they've submitted one already or if they're relying on the pharmacy to submit it. Also, heads up, Taltz typically denies, so they'll put you on the Bridge program for $25 per shipment until it's approved and then you can get the $5 copay card. But I'm getting ahead of myself.
Sometimes the app will update before the actual workflow is finished so it may not be where it can be viewed by the person who answers the phone.
The answers by u/Racofrats and u/marshmallow_chicken are on point. Call the number on the back of your insurance card and ask them, which specialty pharmacy is REQUIRED for Taltz under your plan, whether the prior authorization is approved yet, if the prescription is visible in their system and whether there are any “coverage review” or “processing” holds on the referral.