Some prescription medications may require specialty handling, administration, or require ongoing clinical monitoring. These medications are most commonly used for complex, chronic conditions, and are often very costly.
In recent years, the use of these specialty drugs has increased significantly. To ensure that specialty drugs remain affordable for our members, 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 member or providers.
View our Frequently Asked Questions to learn more about specialty drugs and our fully insured specialty network.
What qualifies a specific drug or therapy to be classified as a specialty pharmaceutical is not 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 are not limited to a specific copayment or coinsurance tier but can be found in all formulary tier levels. Review our specialty drug list* to see if a drug must be filled at one of the specialty network pharmacies.
*The specialty drug list is subject to change and is updated regularly.
Specialty drugs can be covered under a member’s pharmacy benefit or medical benefit, depending on the administration (self-administered or provider-administered)
Specialty Pharmacy Network
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 are 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 does not impact Blue Medicare RxSM, North Carolina State Health Plan (SHP) or Federal Employee Program (FEP) members.
Office-administered Specialty Pharmacy Network
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.
New as of April 2021: The Blue Cross NC Hemophilia Network creates an improved and integrated experience for members that self-administer their hemophilia drugs by allowing specialty pharmacies that meet specific clinical and other criteria 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 members who have an exclusive specialty pharmacy provider, must fill hemophilia medications at a pharmacy participating in the new hemophilia network.
View a list of pharmacies participating in our Hemophilia Network through our Specialty Pharmacy List.