What Specialty Pharmacy Does Blue Cross Blue Shield Use?
- Tony Dean
This program assists in the direct delivery of speciality pharmaceuticals to healthcare practitioners in order to treat patients who have complicated medical diseases. Some of these disorders include, but are not limited to, immunological deficiency, multiple sclerosis, and rheumatoid arthritis.
- Some speciality pharmaceuticals might not be easily accessible at local pharmacies because of the specific standards that must be met for their storage and transportation.
- The member’s benefit determines whether or not they are eligible for coverage of specialty medications.
- There is a possibility that certain speciality pharmaceuticals will still require Prior Authorization or Predetermination approval.
Some members’ benefits may stipulate that they must fill their prescriptions at a particular preferred specialty pharmacy or that they must participate in a split-fill program in order for those benefits to be made available to them. Please see the Medical Policies if you want any clarification on the medical requirements.
- Note: The member’s plan will choose whether benefit, medical coverage or pharmacy coverage, will cover the drug depending on how it is delivered (whether by a physician or by the patient themselves).
- To verify coverage or for more assistance or clarity on your patient’s benefits, please call the number that is printed on the member’s identification card.
Specialty Medications That Patients Administer Themselves In most cases, the member’s pharmacy coverage will pay for specialty pharmaceuticals that have been given the green light for self-administration by the Food and Drug Administration of the United States (FDA).
It is possible that the members’ plans will demand that they purchase these prescriptions from a certain recommended specialty pharmacy in order for the plans to take benefit consideration into account. In order to acquire speciality pharmaceuticals that are suitable for self-administration, Blue Cross and Blue Shield of Illinois (BCBSIL) has entered into a deal with Accredo.
Calling 833-721-1619, e-prescribing the prescription**, or faxing the general reference form are the three ways to get in touch with Accredo. You may get referral forms organized by treatment as well as further information by going to accredo.com/prescribers.
In addition, Accredo provides a prescriber portal via which you may check on the progress of each of your Accredo patients. Additionally, BCBSIL has established contractual relationships with a number of different specialty pharmacies in order to get specific self-administered speciality drugs for its members.
Medication for Specialty Conditions That Must Be Administered By A Doctor BCBSIL has established contractual relationships with a number of different specialty pharmacies in order to get speciality pharmaceuticals for our members’ physicians to administer.
- In most cases, the member’s medical insurance will extend its coverage to include these speciality pharmaceuticals.
- Providers may be eligible for the following benefits as a result of their purchase of specialized drugs from designated specialty pharmacies: Integration of coverage coordination between the member, the supplier, and BCBSIL No initial purchase price is required from providers for speciality drugs that are provided in the office.
Delivery of medication at a time and place that is convenient for the patient (such as the provider’s office, a site of practice, or their home infusion) Injection materials, such as alcohol swabs, needles, and syringes, are included with each and every order (if applicable) Automatic coordination of replenishments of supplies Patient education materials and therapy beginning kits provided by the pharmaceutical company 24 hour helpline manned by registered nurses and/or licensed pharmacists for queries on medicine and injections Observance of policies, procedures, and criteria that are acknowledged at the national level Only when the speciality drug or medications were obtained from the preferred specialty pharmacy may providers bill for the administration of those medications.
- It is not allowed for providers to bill for the specialized drug.
- HMO Illinois ® Specialty Pharmacies That Are Part of the Network Members of HMO Illinois and Blue Advantage HMO SM who have prescription drug benefits that are managed by Prime Therapeutics are required to fill their prescriptions for specialty medications at a pharmacy that is part of the specialty pharmacy network in order to have coverage for those medications considered by their pharmacy benefits.
* Independent contractors is the best way to describe the connection that exists between Blue Cross and Blue Shield of Illinois and the specialty pharmacies. **eRx to NCPDP ID 4436920, 1640 Century Center Parkway, Memphis, Tennessee 38134. Prime Therapeutics, a separate firm, is contracted by Blue Cross and Blue Shield of Illinois (BCBSIL) to offer pharmacy benefit administration and other services linked to it.
- Prime Therapeutics is a company in which BCBSIL, in addition to a number of other independent Blue Cross and Blue Shield Plans, has an ownership interest.
- Accredo is a specialized pharmacy that has a contract with BCBSIL to deliver services to the organization’s members.
- Accredo and BCBSIL operate solely in the capacity of independent contractors in their connection to one another.
Express Scripts Strategic Development, Inc. is the owner of the trademark for the Accredo brand. There is no assurance that there will be advantages associated with the listing of any given medicine or group of pharmaceuticals. The material presented here is provided solely for educational reasons and is not intended to replace the objective diagnosis and treatment recommendations made by a qualified medical professional.
Who is the pharmacy benefit manager for Blue Cross Blue Shield of Texas?
Prime Therapeutics, which serves as our pharmacy benefits manager, is in charge of managing the coverage for prescription drugs that Blue Cross and Blue Shield of Texas (BCBSTX) members receive. Members may go to myPrime.com to do the following: Look for medications that require a prescription.
Are Express Scripts and Accredo the same?
Cigna has decided to work exclusively with Accredo®, a specialty pharmacy that is a division of Express Scripts.