At Retail pharmacies, you can purchase over-the-counter medicines in addition to the medication your doctor prescribes. Specialty pharmacies are different – as a patient of Kroger Specialty Pharmacy, you will receive individualized attention to support your needs. We dispense medications to treat complex conditions including Asthma, Bronchiectasis, Chronic Lung Infections, Idiopathic Pulmonary Fibrosis, and Interstitial Lung Disease. Our highly qualified clinical and patient care teams are specially trained in pulmonary care and their unique skills and experience allow them to navigate the complexities between insurance, healthcare providers, and your medication plan. Our Patient Advocacy team is ready to help with copay assistance, medication management, and support resources. We are focused on your health so that you can focus on what matters most-your healthcare journey.
Kroger Specialty Pharmacy offers many limited distribution pulmonary therapies and ancillary medications. By being your one-stop-shop for medications and supplies, we hope to simplify and streamline the time spent coordinating your medical needs.
All of our dedicated pulmonary team members are knowledgeable and passionate about pulmonary diseases and many are fluent in Spanish.
First time patients receive an initial welcome call to set up account.
For your safety and privacy, we ask identity verification questions on each call.
We will contact you 7-10 days prior to your refill date, allowing us time to process your order.
Patient Care Coordinators proactively contact you to schedule medication refills – according to your preferred method of communication – so you don't have to keep track of refills.
If you prefer email or text refill reminders in place of calls, please let us know.
Each order requires we connect with you to schedule your medication delivery. Please respond, save our phone number, and check your voicemails to ensure prompt deliveries.
Discreet medication delivery to your doorstep at no charge.
We have a Patient Advocacy Team to assist with access, copays, support, and resources.
We do not send automatic refills. If you do not need a refill, please let us know and we will reschedule when you are ready.
Our Nurses provide individualized treatment programs that support your specific health needs. Board Certified pharmacists are available to you 24/7 to answer medication questions.
Director, Patient Access
Manager, Patient Access
Director, Patient Advocacy
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Phase 1: Initial Phase
Your copay can be a set copay or % depending on your plan. Some plans have tiers of copayments for different types of drugs. Once you & your insurance company have spent $4,130 (the combined amount plus your deductible), you fall into phase 2.
Phase 2: Donut Hole/Coverage Gap (37% Copay for Generics; 25% copay for Brand)
You pay 25% of the cost of your brand medication, the insurance pays 5%, and 70% is the manufacturer discount. The combined amount of what you pay & the 70% manufacturer discount is applied to the $6,550 out of pocket (total amount you have paid for all prescriptions on the year) required to get out of the coverage gap.
Phase 3: Catastrophic (5% Copay)
Once you have spent $6,550 out of pocket, you fall into the catastrophic phase for the rest of the calendar year. Standard copays can go up to 5% of the cost of the drug depending on your plan.
*Please note that every year your Medicare phases will start over. For more information go to medicare.gov.
Most Medicare drug plans have a coverage gap (also called the "donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs. Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. Once you and your plan have spent $4,130 on covered drugs in 2021, you're in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.
The Low-Income Subsidy Extra Help program is a discount plan to assist eligible individuals with their Part D Prescription Drug Plan. The LIS program can help pay the Part D monthly premium, lower the cost of prescriptions drugs, and eliminate the “donut hole."
Please refer to the household size and income chart below. You must be at or below 150% of the federal poverty level.
|HH Size #||100%||133%||150%|
You can apply to LIS by calling 800.772.1213 (Monday-Friday 7am-7pm, applying online here, or applying in person at your local Social Security office.
*Copays for 2021 are $9.20 for brand & $3.70 for generic drugs.
Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like copayments, coinsurance and deductibles.
We have a dedicated Patient Advocacy Team for insurance navigation and renewal. Please contact us at 855.274.1694 or firstname.lastname@example.org.
We are privileged to be a part of your care team and will coordinate directly with your doctor's office for prior authorizations, appeals, refills, and anything else needed for your care.
Many of the pulmonary therapies offer copay card programs to those with private/commercial insurance. Most drug manufacturers also offer programs to help patients who are uninsured or underinsured. Additionally, we work with third-party Foundations that assist with copays for eligible patients, such as the HealthWell Foundation.
Our Patient Care Coordinators keep track of your refills and contact you 7-10 days before your refill date. You do not need to keep track of refill dates.
Depending on your insurance plan, your Patient Care Coordinator will discuss your preferred address with you for each refill. We can ship to all 50 states.
Form inquiries are answered within 48 hours of receipt. If you require immediate attention or are experiencing a medical emergency, please call 911.