Specialty Pharmacy Network FAQs
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.
You can transfer any remaining refills on a prescription from your current pharmacy to participating specialty drug network pharmacy by providing your prescription information to the new pharmacy. The new pharmacy will either transfer the prescription or obtain a new prescription for you by contacting your physician.
No, specialty medications are all name brands and not currently available as a generic.
If specialty medications are usually injectable, wouldn't they be covered by the medical benefits of my health plan?
The majority of specialty medications are covered under your medical benefits and administered in a medical office; however, some specialty medications may be oral or self-administered and are covered by your pharmacy benefits. Only the specialty medications covered by your pharmacy benefits will be 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.
I want to keep using my current pharmacy for my nonspecialty medications, but I don't want to travel to another pharmacy just to get my specialty medication filled. What are my options?
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 currently have pharmacy benefits and use specialty drugs, must use the specialty drug network in order for their prescriptions to be covered. This does not impact Blue Medicare RxSM, North Carolina State Health Plan or Federal Employee Program (FEP) members.
Additional pharmacies may join the network at any time. Please continue to refer to the pharmacy list to check for updates.