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Update: Introducing a New Specialty Pharmacy Program, Free Market Health
Update: Article originally posted on August 1, 2023.
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is introducing a new market-based program with Free Market Health (FMH) to help our members get certain covered specialty prescriptions at a lower cost. In an effort to keep health care as affordable as possible, the program will provide an automated system to compare and choose the best fit Blue Cross NC-contracted specialty pharmacy to provide our members' specialty drugs at the lowest cost possible.
The program launched on October 1, 2023, for fully-insured commercial members and will include a subset of specialty medications that Blue Cross NC covers today, including medications used to treat multiple sclerosis, rheumatoid arthritis, cancer and more.
Once approved, prescription referrals for impacted specialty drugs will be sent to FMH for a competitive bidding process, which will give more specialty pharmacies the opportunity to access and fill specialty prescriptions that they previously could not. When specialty pharmacies meet certain high-quality care standards specified for certain prescriptions, they may be eligible for additional reimbursement, in alignment with our commitment to improving outcomes for our members.
Prescribers should continue to submit specialty medication authorization requests as they normally would for prior authorization. If the prescriber or the member has a preference for a specific pharmacy, this should be communicated to Blue Cross NC. If no preference is expressed, authorized referrals will be matched by Free Market Health to a specialty pharmacy best suited to service the member. Prescribers will be contacted by the specialty pharmacy identified to obtain the member’s prescription.
When prescribing specialty medications not included in the FMH program, or for members not enrolled in a fully-insured commercial plan, the process will remain in place as it was prior to the launch of the FMH program. Members with existing specialty prescriptions not included in the program will continue receiving those medications through their current pharmacy provider.
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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