Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is introducing an innovative specialty pharmacy program, Advocate+™ Pharmacy Match, that makes specialty drug care more affordable.
In an effort to keep health care as affordable as possible, the program will provide a market-based system to assign members to the Prime Therapeutics™ contracted specialty pharmacy that can meet their specialty drug needs at the lowest cost possible.
The program launches at renewal after October 1, 2025, for Administrative Services Only (ASO) 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.
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. View the full list of in-network specialty pharmacies included in the Advocate+ Pharmacy Match program.
How does this impact prescribers?
Prescribers should continue to submit specialty medication authorization requests as they normally would for prior authorization. Once the authorization is approved, for medications included in the program, Advocate+ Pharmacy Match will assign the prescription to the specialty pharmacy that agrees to provide the medication to the member at the lowest cost. The assigned specialty pharmacy may then be responsible for reaching out to the prescriber’s office to obtain the prescription and contacting the member to onboard them and initiate service. Prescribers may notice new specialty pharmacies servicing their patients.
View the full list of specialty prescriptions (PDF) included in the Advocate+ Pharmacy Match program.
When prescribing specialty medications not included in the Advocate+ Pharmacy Match program, the process will remain in place as it was prior to the launch of the Advocate+ Pharmacy Match program, where prescribers either recommend a specialty pharmacy or allow members to select their preferred specialty pharmacy. Members with existing specialty prescriptions not included in the program can continue receiving those medications through an in-network specialty pharmacy provider.
Learn more about Advocate+ Pharmacy Match.
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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