Office-administered Specialty Pharmacy Network
The Office-administered Specialty Pharmacy Network is available to supply providers with select specialty injectable drugs for the treatment of Blue Cross and Blue Shield of North Carolina (BCBSNC) patients. With this network, providers can have member-specific, dose-specific drugs delivered directly to their office, and the network vendors will bill BCBSNC 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 BCBSNC directly for the injectable drug
- If a member-specific, dose-specific injectable drug is ordered from a network vender - do not file a claim with BCBSNC for the drug. The vendor will bill BCBSNC directly.
Be advised that certain self-administered drugs have been excluded from BCBSNC'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, BCBSNC will no longer provide reimbursement to physicians for the designated self-administered drugs. For more information, see self-administered injectable drugs.
Please note: 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.
Please note: 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 BCBSNC's medical benefits but are still covered under the prescription drug benefit. For more information, see self–administered injectable drugs.
Some of these drugs listed below may require prior review.
Please note - Unclassified Biologic: When filing a specialty pharmacy drug with an unclassified HCPCS code, the appropriate NDC # must be included on the claim.
The following list of specialty pharmacy drugs are covered under the medical benefit and administered in the provider office. This list applies to all participating in-network providers.
Current Specialty Pharmacy Drugs (as of July 1, 2015)