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 drug 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.