Getting Your Biologic or Specialty Medicine

View/Download Tandem Instructions

Background

When we prescribe a biologic or other specialty medication, we send it to Tandem, a free service that handles prior authorizations, affordability checks, and pharmacy routing so you can start treatment as quickly and affordably as possible.

What to Expect

1) Enroll for text updates (recommended).
Scan the QR code we give you at checkout and follow the prompts to enroll for updates. You can also text “RX” to the number shown on our handout to start SMS updates about your prescription’s status.

2) Insurance & savings review.
Tandem checks your insurance coverage, starts any needed prior authorization (PA), and looks for ways to save (manufacturer copay cards, foundations, cash-price options, etc.).

3) Pharmacy routing.
Your prescription is sent to your insurer-preferred or required specialty pharmacy (or to your preferred pharmacy if allowed). Expect a call/text from that pharmacy to coordinate delivery or pickup.

4) If your insurer denies coverage.
Tandem typically files an appeal automatically and continues working the case. You may be asked to sign a release or provide information. Please reply promptly to any texts/calls from Tandem or the pharmacy.

5) Delivery or pickup.
Once approved (or after any appeal), your medication is dispensed by the appropriate pharmacy and shipped or made available for pickup. You’ll receive text updates at each step if you enrolled.

If Your Medication Is Denied

  • Automatic appeal: Tandem usually initiates the appeal with your insurer.

  • Step-therapy exceptions (Ohio): If your plan requires trying other meds first, medical exceptions can be requested. In Ohio, non-urgent step-therapy appeals must be decided within 10 calendar days (urgent within 48 hours).

  • Your part: Reply to calls/texts, sign any forms sent to you, and let us know if your contact information changes. If you receive any denial letters directly, upload or bring them to us so we can attach them to the appeal.

Ways to Lower Your Cost

Important: Manufacturer copay cards generally work only for commercial (non-government) insurance. If you have Medicare/Medicaid or are uninsured/under-insured, look for Patient Assistance Programs (PAPs) or independent foundations below.

Nonprofit Foundations

Manufacturer Assistance & Savings Links

Tip: If a link says “for HCPs,” that page often still shows patient savings details and has a patient-enrollment link.

Atopic Dermatitis (Eczema) - Systemic

Atopic Dermatitis (Eczema) - Topicals

Psoriasis (Plaque / Guttate / Erythrodermic) & Psoriatic Arthritis

Generalized Pustular Psoriasis (GPP)

Hidradenitis Suppurativa (HS)

Adalimumab (Humira & biosimilars) commonly used in HS/psoriasis

Chronic Spontaneous Urticaria (Chronic Hives)

Prurigo Nodularis

Vitiligo

Alopecia Areata

Basal Cell Carcinoma (Advanced)

Cutaneous T-Cell Lymphoma (MF/SS)

THIS CONTENT IS INTENDED SOLELY FOR EDUCATIONAL PURPOSES AND MAY NOT BE COMPREHENSIVE. IT DOES NOT CONSTITUTE MEDICAL ADVICE. PLEASE REFER TO OUR TERMS OF USE FOR FURTHER DETAILS. ALWAYS CONSULT WITH YOUR HEALTHCARE PROVIDER BEFORE MAKING ANY MEDICAL DECISIONS.