Learn about our pharmacy network, including specialty drug coverage and programs that support our members.
Some prescription medications may require specialty handling, administration, or ongoing clinical monitoring. These medications are most commonly used for complex, chronic conditions, and they're often very costly.
In recent years, the use of these specialty drugs has significantly increased. To ensure that specialty drugs remain affordable for our members, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) contracted with a network of pharmacies committed to providing better pricing on specialty drugs. The network helps to deliver these medications directly to members or providers.
Specialty medications are most commonly used for chronic diseases such as rheumatoid arthritis and multiple sclerosis. These drugs are generally high-cost drugs, ranging from approximately $6,000 to $350,000 per patient, per year. Most specialty drugs are injectable and require special handling and administration. Specialty drugs are not limited to a specific copayment or coinsurance tier, but can be found in all formulary tier levels.
In recent years, the use of specialty drugs has increased significantly and along with that, the cost of covering those drugs. To ensure that specialty drugs remain affordable for our members, Blue Cross NC has contracted with a new network of pharmacies committed to providing better pricing on specialty medications.
With this specialty retail drug network, there may be a limited number of pharmacies dispensing these medications. Since some pharmacies may choose not to participate in the specialty drug network, you may need to transfer your prescription for specialty drugs to a participating local pharmacy or mail order pharmacy. Please refer to the pharmacy list.
Members can transfer any remaining refills from their current pharmacy to a participating specialty pharmacy by providing their prescription information to the new pharmacy. The specialty pharmacy will handle the transfer on the member’s behalf or, if needed, contact the prescriber to request a new prescription.
No. Specialty medications are all name brands and not currently available as a generic.
Many specialty medications are covered under a member’s medical benefits and are typically administered in a medical setting. However, some specialty medications are oral or self‑administered and are covered under the member’s pharmacy benefits instead.
Only specialty medications that are covered under pharmacy benefits are included in this network.
If you have a health savings account or coinsurance plan, when you visit a new network pharmacy, your costs may actually be lower. If you have a copayment plan, you will not see an increase in your out-of-pocket cost as long as you visit a pharmacy participating in the specialty drug network.
Yes. When new medications become available in the therapeutic classes, they will be added to the list. Please refer to the specialty medications list.
You may want to consider mail-order delivery of your specialty medication. There are many specialty pharmacies available that will mail your prescription to your home, under refrigeration, if necessary, and will also provide specialty services such as adherence monitoring and refill reminders.
Blue Cross NC members who have pharmacy benefits and use specialty medications must use the specialty pharmacy network for those prescriptions to be covered.
This requirement does not apply to members in Blue Medicare Rx℠ or the Federal Employee Program® (FEP).
Additional pharmacies may join the network at any time. Please continue to refer to the pharmacy list to check for updates.
The Blue Cross NC Hemophilia Network creates an improved and integrated experience for members self-administering hemophilia drugs by allowing specialty pharmacies that meet specific clinical and other quality to dispense those drugs. The goal of the network is to proactively manage our members with hemophilia in order to lower overall costs and create an individualized and exceptional member experience. Learn more about the Hemophilia Network.
What qualifies a specific drug or therapy to be classified as a specialty pharmaceutical isn't clearly defined. However, the following factors help define a specialty drug:
- The drug(s) requires special handling;
- The drug(s) has a limited distribution and can only be filled at certain pharmacies;
- If the drug(s) treats rare disease(s);
- Or if the drug requires ongoing clinical assessment and / or monitoring of side effects.
Specialty drugs are most commonly used for chronic diseases, such as rheumatoid arthritis and multiple sclerosis. Most specialty drugs are injectable and require special handling and administration. Specialty drugs aren't limited to a specific copayment or coinsurance tier but can be found in all formulary tier levels. Review our Specialty Pharmacy Drug List to see if a drug must be filled at one of the specialty network pharmacies.
Specialty drugs can be covered under a member’s pharmacy benefit or medical benefit, depending on the administration (self-administered or provider-administered).
If a specialty drug is prescribed, members may have to use a certain specialty pharmacy to obtain their medication. Preferred specialty pharmacies vary by plan. Participating specialty pharmacies will provide the following services:
- Educational materials and support to manage the member’s condition
- Free delivery of medication, often by the next day to the location of the member's choice
- Supplies to administer medications, including sharps container, syringes, and injection site supplies, as necessary
- Access to a pharmacist or nurse 24/7
- Working with members to ensure they're taking their medications correctly and being compliant with the drug therapy
- Clinical support for dosing and potential side effects
- Automatic coordination of refills
Review the specialty drug list to see if a drug must be filled at one of the specialty network pharmacies. To locate a participating specialty network pharmacy, please search the Specialty Pharmacy List.
This doesn't impact Blue Medicare Rx℠, North Carolina State Health Plan (SHP), or Federal Employee Program (FEP) members.
The specialty pharmacy network is also contracted to provide specialty drugs for provider administration to Blue Cross NC members. These medications are typically covered under the member’s medical benefit. These pharmacies bill Blue Cross NC directly, making administering specialty injectable drugs easier for providers and members.
The Office-Administered Specialty Pharmacy Network is available to supply providers with select specialty injectable drugs for the treatment of Blue Cross NC patients. With this network, providers can have member-specific, dose-specific drugs delivered directly to their office, and the network vendors will bill Blue Cross NC directly for the drug.
The Office-Administered Specialty Pharmacy Network will:
- Improve access to and simplify the process of obtaining select specialty injectable drugs
- Remove the financial risk providers may have incurred when supplying specialty injectable drugs in the past
- Reduce office paperwork
- Streamline the submission of specialty injectable drug claims
Before you use the Office-Administered Specialty Pharmacy Network, remember:
- Use of the Office-Administered Specialty Pharmacy Network is voluntary.
- Network vendors will bill Blue Cross NC directly for the injectable drug.
- If a member-specific, dose-specific injectable drug is ordered from a network vendor, do not file a claim with Blue Cross NC for the drug. The vendor will bill Blue Cross NC directly.
Be advised that certain self-administered drugs have been excluded from Blue Cross NC's medical benefits but are covered under the prescription drug benefit. In instances when a patient requires assistance with the administration of these drugs, providers can continue to file for administration fees; however, Blue Cross NC will no longer provide reimbursement to physicians for the designated self-administered drugs.
Medicare Supplement subscribers are excluded. Please continue to obtain injectable drugs for these patients through your current process.
The following office-administered specialty drugs may have medical policies or require prior plan approval. For each drug class, each ingredient name is listed with its brand name equivalents in parentheses.
Self-administered specialty drugs covered under the prescription drug benefit must be filled by a pharmacy in the Specialty Pharmacy Network. Certain self-administered drugs have been excluded from Blue Cross NC's medical benefits but are still covered under the prescription drug benefit.
Some of these drugs listed below may require prior review.
When filing a specialty pharmacy drug with an unclassified HCPCS code, the appropriate NDC # must be included on the claim.
These Specialty Pharmacy Drugs (PDF) are covered under the medical benefit and administered in the provider office. This list applies to all participating in-network providers.
The Blue Cross NC Hemophilia Network creates an improved and integrated experience for members self-administering hemophilia drugs by allowing specialty pharmacies that meet specific clinical and other quality measures to dispense those drugs. The goal of the network is to proactively manage our members with hemophilia in order to lower overall costs and create an individualized and exceptional member experience.
Effective April 1, 2021, all specialty medications for the treatment of hemophilia and other bleeding disorders must be dispensed through a pharmacy participating in this network. All commercial members, including self-insured (ASO) members who have an exclusive specialty pharmacy provider, must fill hemophilia medications at a pharmacy participating in the Hemophilia Network.
Effective September 1, 2025, Hemophilia Network specialty pharmacies can participate in the new Value Case Incentive program with Free Market Health – and receive compensation for member onboarding and enhanced disease management reporting. Learn more in this provider news post.
View a list of pharmacies participating in our Hemophilia Network on our Specialty Pharmacy List.
Blue Cross NC has partnered with Free Market Health (FMH) to launch an innovative specialty pharmacy program for our fully insured ACA and commercial members and non-ERISA ASO, North Carolina Chamber of Commerce-MEWA, and balance-funded members.
We’re partnering with Free Market Health to:
- Improve efficiency and care quality while reducing the time it takes for members to receive their specialty medications
- Provide transparent, fair access to authorized referrals for our specialty pharmacy network and recognize high‑quality care
- Use market‑based pricing to help keep specialty drugs affordable for members
Once a prior authorization is approved for select specialty drugs, FMH receives the referral and manages the process. FMH reviews the referral, including the drug, condition, member, and benefit plan. It then matches the referral to the in‑network specialty pharmacy best suited to handle it.
The assigned specialty pharmacy contacts the prescriber to obtain the prescription and works with the member to begin services.
View the list of specialty drugs managed by the FMH program (PDF).
To participate in the FMH program and continue servicing Blue Cross NC fully insured ACA and commercial members after October 1, 2023, specialty pharmacies must sign an addendum or contract with Free Market Health.
When a referral is matched through the program, the assigned specialty pharmacy will contact your office to obtain the prescription, if needed. You may also notice that different in‑network specialty pharmacies are servicing some of your patients.
The specialty pharmacy assigned to the referral has authorization from us to manage and dispense the medication, helping support a more coordinated and efficient referral process.
The FMH specialty drug referral process helps members get their medications faster. It streamlines how referrals are managed after approval, supports first‑fill tracking, and helps reduce the chance that members abandon needed specialty medications.
Members receive their medication through an in‑network specialty pharmacy that’s responsible for meeting their needs and providing focused care management, helping improve the overall experience.
Specialty pharmacies wanting more information on the Free Market Health program or in need of program assistance can contact the Provider Blueline℠ at 800-214-4844 (toll free) or email PNC.SpecialtyPharmUpdates@bcbsnc.com.
Blue Cross NC has partnered with Prime Therapeutics™ (Prime) to launch an innovative specialty pharmacy program, Advocate+ Pharmacy Match, for our Administrative Services Only (ASO) members. The new program orchestrates and optimizes the specialty drug fulfillment process to improve care quality, open fair access to our network pharmacies, and decrease drug costs, utilizing the Free Market Health platform.
- To increase process efficiency, improve care quality, and decrease the time it takes for members to receive their medications.
- To offer transparent and fair access to authorized referrals to our specialty pharmacy network.
- To leverage dynamic market rates at the referral level to ensure specialty drugs remain affordable for our members.
Once a prior authorization is approved for certain specialty drugs, Advocate+ Pharmacy Match receives the referral and begins managing the process.
Here’s how it works:
- Advocate+ Pharmacy Match reviews the referral using program rules and evaluates factors such as the drug, condition, member needs, and benefit plan details.
- The referral, including care responsibilities and any applicable incentives, is matched to the in‑network specialty pharmacy best equipped to support the member.
- An Advocate+ Care Specialist contacts the member to begin onboarding, explains the program, and confirms the assigned specialty pharmacy.
- The assigned specialty pharmacy works with you to obtain the prescription if needed and contacts the member to provide education about their medication and available pharmacy services.
This process helps coordinate care efficiently while ensuring members are supported throughout their specialty therapy.
Specialty pharmacies that participate in the Advocate+ Pharmacy Match program gain several benefits, including:
- More access to approved specialty drug referrals
- Greater control over which types of referrals they choose to pursue
- Reduced time and cost spent on misdirected or non‑actionable referrals
To participate in the Advocate+ Pharmacy Match program – and to continue servicing our Administrative Services Only (ASO) members after July 1, 2025 – network specialty pharmacies are required to sign a contract with Prime Therapeutics.
The specialty pharmacy matched to the referral may reach out to the prescriber office to obtain the prescription, and prescribers may notice new specialty pharmacies servicing their patients. The assigned pharmacy has Blue Cross NC’s authorization to service the referral.
For members, the Advocate+ Pharmacy Match program is designed to make the specialty drug experience simpler and more efficient.
The referral process is managed through the Free Market Health platform, which helps reduce the time it takes for members to receive their medications, monitor first fills, and lower the risk of medication abandonment once a specialty drug is approved.
Members are matched with an in‑network specialty pharmacy that’s responsible for meeting their clinical and service needs and for delivering specialty medications at the lowest possible cost. This approach supports focused care management and a more consistent member experience.
In addition, members receive personalized support from an Advocate+ Care Specialist, who serves as a single point of contact. Care Specialists help simplify the overall experience by offering high‑touch support, including assistance with affordability options and connections to non‑medical resources such as housing, food services, transportation, and other support programs when available.
Specialty pharmacies wanting more information on the Advocate+ Pharmacy Match program or in need of program assistance can contact the Advocate+ Pharmacy Match team at PharmacyMatch@Primetherapeutics.com.
Specialty pharmacies help members get and manage their specialty medicines. They'll deliver them right to a member's home or health care provider on their schedule. Members also have 24-hour access to pharmacists who can answer their questions.
Effective October 1, 2025, Advocate+ Pharmacy Match expands a member's pharmacy network and matches them with a highly qualified pharmacy to fill their specialty medicine(s).
There may be some in-network specialty pharmacies not shown. A member's health plan may require them to use a specific pharmacy for certain specialty medicines based on their benefit coverage.
Members can contact the number located on the back of their member ID card if they have questions.
*Pharmacy Match Network | Phone |
|---|---|
ADVance Care Pharmacy | |
Amber™ Specialty Pharmacy | |
Biologics by McKesson | |
BioPlus® Specialty Pharmacy Services, LLC | |
CareMed Specialty Pharmacy | |
CenterWell™ Pharmacy, Inc. | |
CVS | |
FountainRx | |
Lumicera® Health Services LLC | |
Maxor Specialty Pharmacy | |
Onco360® | |
Optime Care | |
Optum Infusion Pharmacy | |
Optum Rx® | |
Optum Specialty Pharmacy | |
Paragon Healthcare Specialty, LLC | |
Reliance Rx® | |
Restore Rx, Inc. | |
Senderra Specialty Pharmacy | |
Thrifty White Pharmacy | |
Value Specialty Pharmacy | |
Walgreens Specialty Pharmacy | |
Walmart Pharmacy |
*List is subject to change
For all other inquiries, including member support questions, please contact Blue Cross NC at 800-214-4844 or PNC.SpecialtyPharmUpdates@bcbsnc.com.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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