OUR BUSINESS HOURS ARE
MONDAY - FRIDAY 8AM - 6PM
Tel: 843-352-7662
1501 Belle Isle Ave #150 Mount Pleasant SC 29464
Dear Patient,
Welcome to Blue Sky Specialty Pharmacy!
We are excited about the opportunity to
serve you for all of your pharmacy needs.
The team members at Blue Sky Specialty Pharmacy understand that your medical condition is
complex and requires special knowledge when collaborating with your medical provider and
insurance company. We are dedicated to providing you with the personal service necessary to
ensure that you achieve the most benefit from your therapy including:
Access to clinically-trained personnel 24 hours a day, 7 days a week
Coordination of prior authorizations with your insurance company
Compliance monitoring
Free mailing of medication
Training, Education, and Counseling
Refill Reminders
Enrollment in the Patient Management Program which provides such as managing side
effects, increasing compliance to drug therapies, and overall improvement of health
when the patient is willing to follow directions and is compliant to therapy. This
service is provided to you at no cost, and your participation is voluntary. If you no
longer wish to participate in our Patient Management Program, you may contact our
team by phone to opt-out.
We look forward to providing you with the best service possible. We know you have many
options, and we thank you for choosing Blue Sky Specialty Pharmacy.
Sincerely,
The Blue Sky Specialty Pharmacy Team
RARE DISEASE
WHAT TO EXPECT
We recognize that managing a chronic disease or serious illness can feel overwhelming at times and we are
here for you. At Blue Sky Specialty Pharmacy, our team members are dedicated to working with you, your
doctors and nurses, and family and friends to achieve a fully integrated health care team. You are our
primary focus.
Personalized Patient Care
Our specialty trained team members will work with you to discuss your treatment plan and will address any
questions or concerns you may have. We are available for you 24/7
Collaboration with your Doctor
We will always keep the lines of communication open between you and your doctors and caregivers. We are
here to make sure any difficulties you may be having with your treatment are addressed immediately with your
physicians.
Regular Follow Up
Receiving your medications and medical supplies quickly and efficiently is paramount. We will be in close
contact with you during your treatment, and will be your healthcare advocate.
Benefits
Treatment can be costly, and we will help you navigate through the complexities of the healthcare system to
explore every option available to you. Our relationship with insurers will help provide you with information and
explanations of your drug and medical benefits. Your quality of care is our highest mission.
Delivery
We offer fast and convenient delivery to your home, workplace, or the location you prefer. A Blue Sky team
member will contact you 5-7 days prior to our refill due date to coordinate the medications you need, update
your medical and insurance records, and to set up and confirm a delivery date and address.
24/7 Support
Our Blue Sky team members are available 24 hours a day, 7 days a week. We are always here to answer any
questions or address any concerns you may have.
FINANCIAL OBLIGATION AND FINANCIAL ASSISTANCE
Before your care begins, a Blue Sky team member will inform you of the financial obligations you incur that are not
covered by your insurance or other third-party sources. These obligations include but are not limited to: out-of-pocket
costs such as deductibles, copays, co-insurance, annual and lifetime co-insurance limits and changes that occur during
your enrollment period.
INSURANCE CLAIMS
The Blue Sky team will submit claims to your health insurance carrier on the date your prescription is filled. If the claim
is rejected, a Blue Sky team member will notify you so that we can work together to resolve the issue.
CO-PAYMENTS
We are required to collect all co-payments prior to shipment of your medication. Co-payments can be paid by debit /
credit card, electronic checking account debit, over the phone, and by check or money order through the mail.
COPAY ASSISTANCE REFERRAL PROGRAM
We have access to financial assistance programs to help with co-payments and to ensure no interruptions in your
therapy. These programs include discount coupons from drug manufacturers, co-payment vouchers, and assistance
from various disease management foundations and pharmaceutical companies.
WELCOME PACKET
INFORMATION
Blue Sky Specialty Pharmacy | 1501 Belle Isle Ave #150 Mount Pleasant SC 29464 | Tel (843) 352-7662
NOTICE OF PRIVACY PRACTICES
This notice describes how medical information about you may be
used and disclosed and how you can get access to this
information. Please review it carefully. This notice of Privacy
Practices describes how we may use and disclose your protected
health information to carry out treatment, payment or health
care operations and for other purposes that are permitted or
required by law. It also describes your rights to access and
control your protected health information. "Protected health
information" is information about you, including demographic
information, that may identify you and that relates to your past,
present, or future physical or mental health or condition and
related health care services. We are required to abide by the
terms of this Notice of Privacy Practices. We may change the
terms of our notice, at any time the new notice will be effective
for all protected health information that we maintain at that
time. Upon your request, we will provide you with any revised
Notice of Privacy Practices by calling the Pharmacy and
requesting that a revised copy be sent to you in the mail or asking
for one at the time of your next visit.
USES & DISCLOSURES OF PROTECTED HEALTH INFORMATION
Uses and Disclosures of Protected Health Information based upon your written
consent will be asked by your pharmacist to sign a consent form. Once you have
consented to use and disclosure of your protected health information for treatment,
payment and health care operations by signing the consent form, your pharmacist will
use or disclose your protected health information as described in Section 1. Your
pharmacist, our pharmacy staff and others outside of our pharmacy that are involved
in your care and treatment for the purpose of providing health care services to you.
Your protected health information may also be used and disclosed to pay your health
care bills and to support the operation of the pharmacy.
The following are examples of the types of uses and disclosures of your protected
health care information that the pharmacy is permitted to make one you have signed
our consent form. These examples are not meant to be exhaustive, but to describe
the types of uses and disclosures that may be made by our pharmacy once you have
provided consent.
De-identified patient information may be supplied to Pharmacy Hubs to assist in
efficiency and cost reduction efforts to patients surrounding prescription fulfillment.
TREATMENT
We will use and disclose your protected health information to provide, coordinate, or
manage your health care and any related services. This includes the coordination or
management of your health care with a third party that has already obtained your
permission to have access to your protected health information. For example, your
protected health information may be provided to a physician to whom you have been
transferred to ensure that the physician has the necessary information to diagnose or
treat you. In addition, we may disclose your protected health information from time-
to-time to another pharmacy or health care provider (e.g., specialist or laboratory)
who, at the request of your physician, becomes involved in your care by providing
assistance with your health care diagnosis or treatment to your physician.
PAYMENT
Your protected health information will be used, as needed, to obtain payment for
your health care services. This may include certain activities that your health
insurance plan may undertake before it approves or pays for health care services,
such as; making a determination or eligibility of coverage for insurance benefits,
reviewing services provided to you for medical necessity, and undertaking utilization
review activities. For example, obtaining approval for a prescription may require that
your relevant protected health information be disclosed to the health plan to obtain
approval for the prescription.
HEALTH CARE OPERATIONS
We may use or disclose, as-needed, your protected health information in order to
support the business activity of your pharmacy. These activities include, but are not
limited to, quality assessment activities, employee review activities, licensing,
marketing and conducting or arranging for other business activities. For example, we
may ask your name and your physician's name when you deliver a prescription to be
filled. We may also call you by name when your prescription is ready. We may use or
disclose your protected health information, as necessary, to contact you to remind
you of a prescription that has not been picked up. We will share your protected health
information with third party "business associates" that perform various activities (e.g.,
billing services) for the pharmacy. Whenever an arrangement between our pharmacy
and a business associate involves the use or disclosure of your protected health
information, we will have a written contract that contains terms that will protect the
privacy of your protected health information. We may use or disclose your protected
health information, as necessary, to provide you with information about treatment
alternative or other health-related benefits and services that may be of interest to
you. We may also use and disclose your protected health information for other
marketing activities. For example, your name and address may be used to send you a
newsletter about our pharmacy and the services we offer. We may also send you
information about products or services we offer. We may also send you information
about products or services that we believe may be beneficial to you. You may contact
our Privacy Contact to request these materials not be sent to you.
USES & DISCLOSURES OF PROTECTED HEALTH INFORMATION
BASED UPON YOUR WRITTEN AUTHORIZATION
Other uses and disclosures of your protected health information will be made only
with your written authorization, unless otherwise permitted or required by law as
described below. You may revoke this authorization, at any time, in writing, except to
the extent that your pharmacist or the pharmacy has taken an action in reliance on
the use or disclosure indicted in the authorization.
OTHER PERMITTED & REQUIRED USES AND DISCLOSURES
THAT MAY BE MADE WITH YOUR CONSENT, AUTHORIZATION,
OR OPPORTUNITY TO OBJECT
We may use and disclose your protected information in the following instances. You
have the opportunity to agree or object to the use or disclosure of all or part of your
protected health information. If you are not present or able to agree or object to the
use or disclosure of the protected health information, then your pharmacist may,
using professional judgement, determine whether the disclosure is in your best
interest. In this case, only the protected health information that is relevant to your
health care will be disclosed.
Others involved in Your Health Care: unless you object, we may disclose to a member
of your family, a relative, a close friend or any other person you identify, your
protected health information that directly relates to that person's involvement in
your health care. If you are unable to agree or object to such a disclosure, we may
disclose such information as necessary if we determine that it is in your best interest
based on our professional judgement. We may use of disclose your protected health
information to an authorized public or private entity to assist in disaster relief efforts
and to coordinate uses and disclosures to family or other individuals involved in your
health care.
EMERGENCIES
We may use or disclose your protected health information in an emergency
treatment situation. If this happens, your pharmacist shall try to obtain your consent
as soon as reasonably practicable after the delivery of treatment. If you pharmacist is
required by law to treat you and has attempted to obtain your consent, he or she may
still use or disclose your protected health information to treat you.
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WELCOME PACKET
COMMUNICATION BARRIER
We may use and disclose your protected health information if your pharmacist
attempts to obtain consent from you but is unable to do so due to substantial
communications barriers and the pharmacist determines, using professional
judgement, that your intent to consent to use or disclose under the circumstances.
Other permitted and required uses and disclosures that may be made without your
consent, authorization or opportunity to object.
We may use or disclose your protected health information in the following situations
without your consent or authorization. These situations include:
REQUIRED BY LAW
We may use or disclose your protected health information to the extent that the
use or disclosure is required by law. The use or disclosure will be made in
compliance with the law and will be limited to the relevant requirements of the
law. You will be notified, as required by law, of any such uses or disclosures.
PUBLIC HEALTH
We may disclose your protected health information for public health activities and
purposes to a public health authority that is permitted by law to collect or receive
the information. The disclosure will be made for the purpose of controlling
disease, injury, or disability. We may also disclose your protected health
information, if directed by the public health authority, to a foreign government
agency that is collaborating with the public health authority.
Health Oversight: We may disclose protected health information to a health
oversight agency for activities authorize by law, such as audits, investigations, and
inspections. Oversight agencies seeking this information include government
agencies that oversee the health care system, government benefit programs, other
government regulatory programs and civil rights laws.
ABUSE OR NEGLECT
We may disclose your protected health information to a public health authority
that is authorized by law to receive reports of child abuse or neglect. In addition,
we may disclose your protected health information if we believe that you have
been a victim of abuse, neglect, or domestic violence to the government entity or
agency authorized to receive such information. In this case, the disclosure will be
made consistent with the requirements of applicable federal and state laws.
FOOD & DRUG ADMINISTRATION
We may disclose protected health information to a person or company required by
the Food and Drug Administration to report adverse events, product defects or
problems, biologic product deviations, track products; to enable product recalls;
to make repairs or replacements, or to conduct post marketing surveillance, as
required.
LEGAL PROCEEDINGS
We may disclose protected health information in the course of any judicial or
administrative proceeding; in response to an order of a court or administrative
tribunal (to the extent such disclosure is expressly authorized), in certain
conditions in response to a subpoena, discovery request or other lawful proceeds.
LAW ENFORCEMENT
We may disclose protected health information, so long as applicable legal
requirements are met, for law enforcement purposes. These law enforcement
purposes include (1) Legal processes and otherwise required by law, (2) Limited
information request for identification and location purposes, (3) Pertaining to
victims of a crime, (4) suspicion that death has occurred as a result of criminal
conduct, (5) In the event that a crime occurs on the premises of the pharmacy and
(6) medical emergency (not on the pharmacy's premises) and it is likely that a
crime has occurred.
CRIMINAL ACTIVITY
Consistent with applicable federal and state laws, we may disclose your protected
health information, if we believe that the use or disclosure is necessary to prevent
or lessen a serious and imminent threat to the health or safety of a person or the
public. We may also disclose protected health information if it is necessary for law
enforcement authorities to identify or apprehend an individual.
WORKER'S COMPENSATION
Your protected health information may be disclosed by us as authorized to comply
with worker's compensation law and other similar legally established programs.
INMATES
We may use or disclose your protected health information if you are an inmate of a
correctional facility and your pharmacy created or received your protected health
information in the course of providing care to you.
REQUIRED USES AND DISCLOSURES
Under the law, we must make disclosures to you and when required by the Secretary
of the Department of Health and Human Services to investigate or determine our
compliance with the requirements of Section 164.500 et. Seq.
YOUR RIGHTS
The following is a statement of your rights with respect to your protected health information and a brief description of how
you may exercise these rights.
YOU HAVE THE RIGHT TO INSPECT AND COPY YOUR PROTECTED HEALTH INFORMATION
This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as
we maintain the protected health information. A "designated record set" contains prescription and billing records and any other records that your
pharmacy uses for making decisions about you. Under Federal Law, however, you may not inspect or copy the following records: information
complied in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceedings, and protected health information that is
subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable.
In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Contact if you have questions about access to
your medical record.
YOU HAVE THE RIGHT TO REQUEST A RESTRICTION OF YOUR PROTECTED HEALTH INFORMATION
This means you may ask us not to use or disclose any part of your protected information for the purposes of treatment, payment, or healthcare
operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be
involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction.
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YOU HAVE THE RIGHT TO PERMIT INDIVIDUALS TO REQUEST CONFIDENTIAL COMMUNICATIONS OF PHI BY ALTERNATIVE MEANS OR AT ALTERNATIVE
LOCATIONS
YOU HAVE THE RIGHT TO AMEND PROTECTED HEALTH INFORMATION
WELCOME PACKET
LANGUAGE TRANSLATION
We have free interpreter services to answer any questions you may have about your medication. To get an interpreter,
please call us at 843-352-7662
Contamos con servicios de interpretación gratuitos para responder cualquier pregunta que pueda tener sobre su plan de salud o de medicamentos. Para obtener un intérprete,
simplemente llámenos al 1-843-352-7662. Alguien que hable español te puede ayudar. Este es un servicio gratuito
SPANISH
1-843-352-7662
Wǒmen tígōng miǎnfèi de kǒuyì fúwù lái huídá nín kěnéng duì nín de jiànkāng huò yàowù jìhuà tíchū de rènhé wèntí. Yào huòdé kǒuyì yuán, zhǐ xūzhìdiàn 1- 843-352-7662 liánxì
wǒmen. Huì shuō zhōngwén de rén kěyǐ bāngzhù nín. Zhè shì yī xiàng miǎnfèi fúwù
CHINESE
Mayroon kaming mga libreng serbisyo ng interpreter upang sagutin ang anumang mga katanungan na maaaring mayroon ka tungkol sa iyong plano sa kalusugan o gamot. Para
makakuha ng interpreter, tawagan lang kami sa 1-843-352-7662. Maaaring makatulong sa iyo ang isang taong nagsasalita ng Tagalog. Ito ay isang libreng serbisyo.
TAGALOG
Nous avons des services d'interprètes gratuits pour répondre à toutes vos questions concernant votre régime d'assurance-maladie ou d'assurance-médicaments. Pour obtenir un
interprète, appelez-nous au 1-843-352-7662. Quelqu'un qui parle français peut vous aider. C'est un service gratuit
FRENCH
Chúng tôi có các dịch vụ thông dịch viên miễn phí để trả lời bất kỳ câu hỏi nào mà quý vị có thể có về chương trình sức khỏe hoặc thuốc của mình. Để có thông dịch viên, chỉ cần
gọi cho chúng tôi theo số 1-843-352-7662. Ai đó nói tiếng Việt có thể giúp bạn. Đây là một dịch vụ miễn phí.
VIETNAMESE
Wir haben kostenlose Dolmetscherdienste, um alle Ihre Fragen zu Ihrer Gesundheit oder Ihrem Medikamentenplan zu beantworten. Um einen Dolmetscher zu bekommen, rufen Sie
uns einfach unter 1-843-352-7662 an. Jemand, der Deutsch spricht, kann Ihnen helfen. Dies ist ein kostenloser Service.
GERMAN
. 1-843-352-7662 .
. .
jeohuineun gwihaui geongang ttoneun uiyagpum peullaen-e gwanhan jilmun-e dabbyeonhae deulineun mulyo tong-yeog seobiseuleul jegonghabnida. tong-yeogsaleul chaj-
eulyeomyeon 1-843-352-7662lo jeonhwahasibsio. hangug-eoleul hal jul aneun salam-i dowajul su issseubnida. igeos-eun mulyo seobiseu-ibnida.
KOREAN
У нас есть бесплатные услуги устного переводчика, чтобы ответить на любые ваши вопросы о вашем здоровье или плане лекарств. Чтобы получить переводчика,
просто позвоните нам по телефону 1-843-352-7662. Вам поможет тот, кто говорит по-русски. Это бесплатный сервис.
U nas yest' besplatnyye uslugi ustnogo perevodchika, chtoby otvetit' na lyubyye vashi voprosy o vashem zdorov'ye ili plane lekarstv. Chtoby poluchit' perevodchika, prosto pozvonite
nam po telefonu 1-843-352-7662. Vam pomozhet tot, kto govorit po-russki. Eto besplatnyy servis.
RUSSIAN
بﺮﻌﻟا ﺔﻐﻠﻟا ثﺪﺤﺘﻳ يﺬﻟا ﺺﺨﺸﻠﻟ ﻦﻜﻤﻳ .1-843-352-7662 ﲆﻋ ﺎﻨﺑ ﻞﺼﺗا ﻂﻘﻓ ، ﻢﺟﺮﺘﻣ ﲆﻋ لﻮﺼﺤﻠﻟ .ﻚﺑ ﺔﺻﺎﺨﻟا ﺔﻳودﻷا ﺔﻄﺧ وأ ﻚﺘﺤﺻ لﻮﺣ ﻚﻳﺪﻟ نﻮﻜﺗ ﺪﻗ ﺔﻠﺌﺳأ يأ ﲆﻋ ﺔﺑﺎﺟﻺﻟ يرﻮﻓ ﻢﺟﺮﺘﻣ تﺎﻣﺪﺧ ﺎﻨﻳﺪﻟ
ﺔﻴﻧﺎﺠﻣ ﺔﻣﺪﺧ ﻲﻫ هﺬﻫ .ﻚﺗﺪﻋﺎﺴﻣ.
ladayna khidamat mutarjim fawriun lil'iijabat ealaa 'ayi 'asyilat qad takun ladayk hawl sihatik 'aw khutat al'adwiat alkhasat bika. lilhusul ealaa mutarjim , faqat atasal bina ealaa 7662-
352-843-1. yumkin lilshakhs aladhi yatahadath allughat alearabiat musaeadatuka. hadhih hi khidmat majaaniatun.
ARABIC
Disponiamo di servizi di interpretariato gratuiti per rispondere a qualsiasi domanda tu possa avere sul tuo piano sanitario o farmacologico. Per ottenere un interprete, chiamaci al
numero 1-843-352-7662. Qualcuno che parla italiano può aiutarti. Questo è un servizio gratuito.
ITALIAN
Temos serviços de intérprete gratuitos para responder a quaisquer perguntas que você possa ter sobre seu plano de saúde ou medicamentos. Para obter um intérprete, ligue para
1-843-352-7662. Alguém que fale português pode te ajudar. Este é um serviço gratuito.
PORTUGUESE
Nou gen sèvis entèprèt gratis pou reponn nenpòt kesyon ou ka genyen sou plan sante w oswa sou plan medikaman w. Pou jwenn yon entèprèt, jis rele nou nan 1-843-352-7662. Yon
moun ki pale kreyòl ka ede w. Sa a se yon sèvis gratis
CREOLE
Oferujemy bezpłatne usługi tłumacza, który odpowie na wszelkie pytania dotyczące Twojego planu zdrowotnego lub narkotykowego. Aby uzyskać tłumacza, zadzwoń do nas pod
numer 1-843-352-7662. Ktoś, kto mówi po polsku, może ci pomóc. To jest bezpłatna usługa.
POLISH
आपके वाय या दवा योजना के बारे म आपके कसी भी का उर देने के लए हमारे पास मुत भाषया सेवाएं ह। भाषया ात करने के लए, बस हम 1-843-352-7662 पर कॉल कर। कोई हनडी बोलने वाला आपक मदद कर
सकता है। यह एक नःशुक सेवा है।
aapake svaasthy ya dava yojana ke baare mein aapake kisee bhee prashn ka uttar dene ke lie hamaare paas mupht dubhaashiya sevaen hain. dubhaashiya praapt karane ke lie, bas
hamen 1-843-352-7662 par kol karen. koee hinidee bolane vaala aapakee madad kar sakata hai. yah ek nihshulk seva hai.
HINDI
1-843-352-7662
Kenkō ya kusuri no keikaku ni tsuite no shitsumon'nikotaeru muryō no tsūyaku sābisu ga arimasu. Tsūyaku o go kibō no baai wa, 1 - 843 - 352 - 7662 made o denwa kudasai. Nihongo
o hanaseru hito ga anata o tasukete kuremasu. Kore wa muryō no sābisudesu.
JAPANESE
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WELCOME PACKET
PATIENT BILL OF RIGHTS AND RESPONSIBILITIES
Blue Sky Specialty Pharmacy recognizes that patients have inherent rights. Patients who feel their rights have not been
respected, or who have questions or concerns, should speak to the Director of Pharmacy. Patients and their families
also have responsibilities while under the care of Blue Sky Specialty Pharmacy in order to facilitate the provision of
safe, high-quality health care for themselves and others.
PATIENTS RIGHTS & RESPONSIBILITIES
To ensure the finest care possible, as a patient receiving our
Pharmacy services, you should understand your role, rights and
responsibilities involved in your own plan of care.
PATIENT RIGHTS
To select those who provide you with Pharmacy services
To receive the appropriate or prescribed services in a professional manner
without discrimination relative to your age, sex, race, religion, ethnic origin,
sexual preference or physical or mental handicap
To be treated with friendliness, courtesy and respect by each and every individual
representing our Pharmacy, who provided treatment or services for you and to be
free from neglect or abuse, be it physical or mental
To assist in the development and preparation of your plan of care that is designed
to satisfy, as best as possible, your current needs, including management of pain
To be provided with adequate information from which you can give your informed
consent for commencement of services, the continuation of services, the transfer
of services to another health care provider, of the termination of services
To express concerns, grievances, or recommend modifications to your pharmacy
services, without fear of discrimination or reprisal
To request and receive complete and up-to-date information relative to your
condition, treatment, alternative treatments, risk of treatment or care plans
To receive treatment and services within the scope of your plan of care, promptly
and professional, while being fully informed as to your pharmacy's policies,
procedures and charges
To request and receive data regarding treatment, services, or costs thereof,
privately and with confidentially
To be given information as it relates to the uses and disclosure of your plan or
care
To have your plan of care remain private and confidential, except as required and
permitted by law
To receive instructions on handling drug recall
To confidentiality and privacy of all information contained in the client / patient
record and of Protected Health Information; PHI will only be shared with the
Patient Management Program in accordance with State and Federal law
To receive information on how to access support from consumer advocates
groups
To receive pharmacy health and safety information to include consumers' rights
and responsibilities
To know about the philosophy and characteristics of the Patient Management
Program
To have personal health information shared with the Patient Management
Program only in accordance with State and Federal law
To identify the program's staff members, including the program and their job
title, and to speak with a supervisor of the staff member's if requested
To speak to a health care professional
To receive information about the Patient Management Program
To receive administrative information regarding changes in or termination of the
Patient Management Program
To decline participation, revoke consent or dis-enroll at any point in time
To be fully informed in advance about care / service to be provided, including the
disciplines that furnish care and the frequency of visits, as well as any
modifications to the plan of care
To be informed, both orally and in writing, in advance of care being provided, of
the charges for which the client / patient will be responsible
To receive information about the scope of services that the organization will
provide and specific limitations on those services
To participate in the development and periodic revision of the plan of care
To refuse care or treatment after the consequences of refusing care or treatment
are fully presented
To be informed of client / patient rights under state law to formulate an
Advanced Directive, if applicable
To have one's property and person treated with respect, consideration, and
recognition of client / patient dignity and individuality
To be able to identify visiting personnel members through proper identification
To be free from mistreatment, neglect, or verbal, mental, sexual, and physical
abuse, including injuries of unknown source, and misappropriation of client /
patient property
To voice grievances / complaints regarding treatment or care, lack of respect of
property or recommend changes in policy, personnel, or care / service without
restraint, interference, coercion, discrimination, or reprisal
To have grievances / complaints regarding treatment or care that is (or fails to be)
furnished, or lack of respect of property investigated
To have confidentiality and privacy of all information contained in the client /
patient record and of protected health information
To be advised on agency's policies and procedures regarding the disclosure of
clinical records
To choose a health care provider, including choosing an attending physician, if
applicable
To receive appropriate care without discrimination in accordance with physician
orders, if applicable
To be informed of any financial benefits when referred to an organization
To be fully informed of one's responsibilities
The following patient rights and responsibilities shall be provided to, and expected from, patients or legally authorized
individuals.
To provide accurate and complete information regarding your past and present
medical history
To agree to a schedule of services and report any cancellation or scheduled
appointments and / or treatments
To participate in the development and updating of a plan of care
To communicate whether you clearly comprehend the course of treatment and
plan of care
To comply with the plan of care and clinical instructions
To accept responsibility for your actions, if refusing treatment or not complying
with, the prescribed treatment and services
To respect the rights of pharmacy personnel
To notify your physician and the pharmacy with any potential side effects and / or
complications
To notify Blue Sky Specialty Pharmacy via telephone when medication supply is
running low so refill may be shipped to you promptly
To submit any forms that are necessary to participate in the program to the
extent required by law
To give accurate clinical and contact information and to notify the Patient
Management Program of changes in this information
To notify their treating health care provider of their participation in the Patient
Management Program, if applicable
PATIENT RESPONSIBILITIES
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WELCOME PACKET
MEDICARE DMEPOS SUPPLIER STANDARDS
Please Note: This is an abbreviated version of the supplier standards every Medicare DMEPOS supplier must meet in
order to obtain and retain their billing privileges. These standards, in their entirety, are listed in 42 C.F.R. 424.57(c).
A supplier must be in compliance with all applicable Federal and State licensure and regulatory requirements.
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1.
A supplier must provide complete and accurate information on the DMEPOS supplier application. Any changes to this information must be reported to the National
Supplier Clearinghouse within 30 days.
2.
A supplier must have an authorized individual (whose signature is binding) sign the enrollment application for billing privileges.3.
A supplier must fill orders from its own inventory, or contract with other companies for the purchase of items necessary to fill orders. A supplier may not contract
with any entity that is currently excluded from the Medicare Program, any State health care programs, or any other Federal procurement or non-procurement
programs.
4.
A supplier must advise beneficiaries that they may rent or purchase inexpensive or routinely purchased durable medical equipment, and of the purchase option for
capped rental equipment.
5.
A supplier must notify beneficiaries of warranty coverage and honor all warranties under applicable State law, and repair or replace free of charge Medicare covered
items that are under warranty.
6.
A supplier must maintain a physical facility on an appropriate site and must maintain a visible sign with posted hours of operation. The location must be accessible to the
public and staffed during posted hours of business. The location must be at least 200 square feet and contain space for storing records.
7.
A supplier must permit CMS or its agents to conduct on-site inspections to ascertain the supplier's compliance with these standards.8.
A supplier must maintain a primary business telephone listed under the name of the business in a local directory or a toll free number available through directory
assistance. The exclusive use of a beeper, answering machine, answering service or cell phone during posted business hours is prohibited.
9.
A supplier must have comprehensive liability insurance in the amount of at least $300,000 that covers both the supplier's place of business and all customers and
employees of the supplier. If the supplier manufactures its own items, this insurance must also cover product liability and completed operations.
10.
A supplier is prohibited from direct solicitation to Medicare beneficiaries. For complete details on this prohibition see 42 CFR § 424.57 (c)(11).11.
A supplier is responsible for delivery of and must instruct beneficiaries on the use of Medicare covered items, and maintain proof of delivery and beneficiary
instruction.
12.
A supplier must answer questions and respond to complaints of beneficiaries, and maintain documentation of such contacts.13.
A supplier must maintain and replace at no charge or repair cost either directly, or through a service contract with another company, and Medicare-covered items it
has rented to beneficiaries.
14.
A supplier must accept returns of substandard (less than full quantity for a particular item) or unsuitable items (inappropriate for the beneficiary at the time it was
fitted and rented or sold) from beneficiaries.
15.
A supplier must disclose these standards to each beneficiary it supplies a Medicare-Covered item.16.
A supplier must disclose any person having ownership, financial, or control interest in the supplier.17.
A supplier must not convey or reassign a supplier number; 1.e., the supplier may not sell or allow another entity to use its Medicare billing number.18.
A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must
be maintained at the physical facility.
19.
Complaint records must include: the name, address, telephone number and health insurance claim number of the beneficiary, a summary of the compliant, and any
actions taken to resolve it.
20.
A supplier must agree to furnish CMS any information required by the Medicare statute and regulations.21.
All suppliers must be accredited by a CMS-approved accreditation organization in order to receive and retain a supplier billing number. The accreditation must
indicate the specific products and services, for which the supplier is accredited in order for the supplier to receive payment for those specific products and services
(except for certain exempt pharmaceuticals)
22.
All suppliers must notify their accreditation organization when a new DMEPOS location is opened.23.
All supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards and be separately accredited in order to bill Medicare.24.
All suppliers must disclose upon enrollment all products and services, including the addition of new product lines for which they are seeking accreditation.25.
A supplier must meet the surety bond requirements specified in 42 CFR § 424.57 (d).26.
A supplier must obtain oxygen from a state-licensed oxygen supplier.27.
A supplier must maintain ordering and referring documentation consistent with provisions found in CFR § 424.516 (f).28.
A supplier is prohibited from sharing a practice location with other Medicare providers and suppliers.29.
A supplier must remain open to the public for a minimum of 30 hours per week except physicians (as defined in section 1848(j) (3) of the Act) or physical and
occupational therapists or a DMEPOS supplier working with custom made orthotics and prosthetics.
30.
Medicare DMEPOS Supplier have the option to disclose the following statement to satisfy the requirement outlined in
Supplier Standard 16 in lieu of providing a copy of the standards to the beneficiary. The products and / or services
provided to you by (supplier legal business name or DBA) are subject to the supplier standards contained in the Federal
regulations shown at 42 Code of Federal Regulations Section 424.57 (c). These standards concern business professional
and operational matters (e.g. honoring warranties and hours of operation).
The full text of these standards can be obtained at http://ecfr.gov. Upon request we will furnish you a written copy of the standards.
WELCOME PACKET
ADDITIONAL INFORMATION
ADVERSE EFFECTS TO MEDICATION
If you are experiencing adverse effects to the medication, please contact your physician or one of the Blue Sky Specialty Pharmacy
Team Members
DRUG SUBSTITUTION PROTOCOLS
From time-to-time it is necessary to substitute generic drugs for brand name drugs. This could occur due to your insurance company
preferring the generic be dispensed or to reduce your copay. If a substitution needs to be made, a Blue Sky Team Member will
contact you prior to shipping the medication to inform you of the substitution.
COMPLAINTS
Patients and caregivers have the right to voice complaints and / or recommendations on services to Blue Sky Specialty Pharmacy.
Patients and caregivers can do so by phone, fax, writing, or email.
South Carolina Board of Pharmacy
Website: https://llr.sc.gov/fileacomplaint.aspx
Tel: 803-896-4300
Email: [email protected]
URAC Complaint Info
Website: https://www.urac.org/complaint/
Tel: 202-216-9010
Email: [email protected]
ACHC Complaint Info
Website: https://achc.org/contact/complaint-policy-process
Tel: 919-785-1214, Toll Free: 855-937-2242 (Request the Complaints Department)
HHS Complaint Info
Website: https://www.hhs.gov/hipaa/filing-a-complaint/index.html
Email: [email protected]
Georgia Board of Pharmacy
Address: 2 Peachtree Street, Atlanta GA 30303
Tel: 404-651-8000
Texas Board of Pharmacy
Address: 333 Guadalupe Street #3, Austin TX 78701
Tel: 512-305-8000
PROPER DISPOSAL OF UNUSED MEDICATIONS
For instructions on how to properly dispose of unused medications, please contact Blue Sky Specialty Pharmacy for instructions or
go to the below websites for information and instructions.
*PLEASE DO NOT FLUSH MEDICATIONS DOWN THE TOILET*
http://www.fda.gov/forconsumers/consumerupdates/ucm101653.htm
http://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/ensuringsafeuseofmedicine/safedisposalofmedicines/ucm186187.htm
PATIENT SUPPORT GROUPS, EDUCATION, AND TRAINING
Support
Visit https://www.mayoclinic.org
Type in your disease state / condition into the search bar and select the disease state
On the left hand side, click "Coping and Support"
Education and Injection Training
Refer to the manufacturer's website for proper use of injections and education
REFILLS
To place a refill for a medication or to fill a new medication, please call Blue Sky at 843-352-7662
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WELCOME PACKET
EMERGENCY & DISASTER PREPAREDNESS PLAN
If you are not in the tristate area and are aware you will be experiencing inclement weather, you are responsible for
calling the pharmacy 3-5 days before the occurrence.
The Pharmacy will call you 3-5 days before an inclement weather emergency such as a snowstorm utilizing the
weather updates as a point of reference
1.
Blue Sky Specialty Pharmacy has a comprehensive emergency preparedness plan in case a disaster occurs. Disasters
may include fire to our facility, chemical spills in the community, hurricanes, snow storms, tornadoes, and community
evacuations. Our primary goal is to continue to service your prescription care needs. When there is a threat of disaster
or inclement weather in the local area, Blue Sky Specialty Pharmacy will contact you prior to any atrocities the city may
encounter. However, if there will be a threat of disaster or inclement weather in an area you reside which is outside of
the tristate area, it is your responsibility to contact the pharmacy prior to the occurrence (if permissible). This process
will ensure you have enough medication to sustain you.
Blue Sky Specialty Pharmacy will utilize every resource available to continue to service you. However, there may be
circumstances where Blue Sky Specialty Pharmacy cannot meet your needs due to the scope of the disaster. In that
case, you must utilize the resources of your local rescue or medical facility. Please read the guide below to aide you in
the case of an emergency or disaster.
2. The Pharmacy will send your medication via courier or UPS Next Day delivery during any suspected inclement
weather emergency
3. If the Pharmacy cannot get your medication to you before an inclement weather emergency occurrence, the
pharmacy will transfer your medication to a local specialty pharmacy so you do not go without medication
4. If a local disaster occurs and the Pharmacy cannot reach you or you cannot reach the Pharmacy, please listen
to your local news and rescue centers for advice on obtaining medication. Visit your local hospital immediately if
you will miss a dose
5. The Pharmacy recommends all patients leave a secondary emergency phone numner.
If you have an emergency that is not environmental but personal and you need your medication, please contact the
Pharmacy at your convenience and we will assist you.
CLEANING YOUR HANDS
The most important step to prevent the spread of germs and infections is hand washing. Wash your hands often. Be
sure to wash your hands each time you touch any blood or body fluids, touch bedpans, dressings, or other soiled
items, use the bathroom or bedpan.
If you are coughing, sneezing, or blowing your nose, clean your hands often. Before you eat, always clean your hands.
How You Should Clean Your Hands with
Wet your hands and wrists with warm water
Use soap. Work up a good lather, and rub
hard for 15 seconds or longer
Rinse your hands well
Dry your hands well
Use a clean paper towel to turn off the
water and throw the paper towel away
How You Should Clean Your Hands with
For gel product, use one application
For foam product, use a golf ball size
amount
Apply product to the palm of your hand
Rub your hands together. Cover all surfaces
of your hands and fingers until they are dry
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SOAP AND WATER HAND SANITIZER
WELCOME PACKET
HOME SAFETY INFORMATION
Here are some helpful guidelines to help you keep a careful eye on your home and maintain safe habits. The safe way is
always the right way to do things - shortcuts may hurt. Correct unsafe conditions before they cause an accident. Take
responsibility. Keep your home safe. Keep emergency phone numbers handy.
Stand close to the load with your feet apart for good balance
Bend your knees and straddle the load
Keep your back as straight as possible while you lift and carry the load
Avoid twisting your body when carrying a load
Plan ahead - clear your way
MEDICATION
If children are in the home, store medications and poisons in childproof containers and out of reach
All medication should be labeled clearly and left in original containers
Do not give or take medication that were prescribed for other people
When taking or giving medication, read the label and measure doses carefully. Know the side effects of the medication you are
taking
MOBILITY ITEMS
When using mobility items to get you around such as; canes, walkers. wheelchairs, or crutches you should use extra
care to prevent slips and falls.
Use extreme care to avoid using walkers, canes or crutches on slippery or wet surfaces
Always put the wheelchairs or seated walkers in the lock position when standing up or before sitting down
Wear shoes when using these items and be try to avoid obstacles in your path and soft and uneven surfaces
SLIPS AND FALLS
Slip and falls are the most common and often the most serious accidents in the home. Here are some things you can do
to prevent them in your home
Arrange furniture to avoid an obstacle course
Install handrails on all stairs, showers, bathtubs, and toilets
Keep stairs clear and well lit
Place rubber mats or grids in showers and bath tubs
Use bath benches or shower chairs if you have muscle weakness, shortness or breath, or dizziness
Wipe up all spilled water, oil or grease immediately
Pick up and keep surprises out from under foot including electrical cords and rugs
Keep drawers and cabinets closed
Install good lighting to avoid groping in the dark
LIFTING
If it is too big, too heavy, or too awkward to move alone, GET HELP. Here are some things you can do to prevent low
back pain or injury
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Install smoke detectors. They are your best early warning. Test frequently and change the battery every year
If there is oxygen in use, place a "No Smoking" sign in plain view of all persons entering the home
Throw away old newspapers, magazines, and boxes
Empty wastebaskets and trash cans regularly
Do now allow ashtrays or toss matches into wastebaskets unless you know they are out. Wet down first or dump
into toilet
Have your chimney and fireplace checked frequently. Look for and repair cracks and loose mortar. Keep paper,
wood and rugs away from area where sparks could hit them
Be careful when using space heaters
Follow instructions when using heating pad to avoid serious burns
Check your furnace and pipes regularly. If nearby walls or ceilings feel hot, add insulation
Keep a fire extinguisher in your home and know how to use it
Open windows and doors
Shut off appliance involved. You may be able to refer to the front of your telephone book for instructions regarding
turning off the gas to your home
Don't use matches or turn on electrical switches
Don't use the telephone - dialing may create electrical sparks
Don't light candles
Call Gas Company from a neighbor's home
If your Gas Company offers free annual inspections, take advantage of them
WELCOME PACKET
SMELL GAS?
FIRE
Pre-plan and practice your fire escape. Look for a plan at least two ways out of your home. If your fire exit is through a
window, make sure if opens easily. If you are in an apartment, know where the exit stairs are located. Do not use the
elevator in a fire emergency. You may notify the fire department ahead of time if you have a disability or special needs.
Here are some steps to prevent fires:
If you have a fire or suspect fire
Take immediate action per plan - Escape is your top priority
Get help on the way - with no delay, CALL 911
If your fire escape is cut off, close the door and seal the cracks to hold back smoke. Signal help from the window
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