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The Office-administered Specialty Medication 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 medications delivered directly to their office, and the network vendors will bill BCBSNC directly for the drug.
The Office-administered Specialty Medication Network will:

  • Improve access to and simplify the process of obtaining select specialty injectable medications
  • Remove the financial risk providers may have incurred when supplying specialty injectable medications in the past
  • Reduce office paperwork
  • Streamline the submission of specialty injectable medication claims

Before you use the Office-administered Specialty Medication Network, remember:

  • Use of the Office-administered Specialty Medication Network is voluntary
  • Network vendors will bill BCBSNC directly for the injectable medication
  • If a member-specific, dose-specific injectable drug is ordered from a network vender - do not file a claim with BCBSNC for the medication. The vendor will bill BCBSNC directly.

Be advised that certain self-administered medications 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 medications, providers can continue to file for administration fees; however, BCBSNC will no longer provide reimbursement to physicians for the designated self-administered medications. For more information, see self-administered injectable medications.

Please note: Medicare Supplement subscribers are excluded. Please continue to obtain injectable medication for these patients through your current process.

The following office–administered specialty medications 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 medications covered under the prescription drug benefit must be filled by a pharmacy in the Specialty Pharmacy Network. Certain self–administered medications have been excluded from BCBSNC's medical benefits but are still covered under the prescription drug benefit. For more information, see self–administered injectable medications.

Some of these medications listed below may require prior review.

Current Specialty Pharmacy Drugs (as of March 3, 2014)

*Note: New Class Names, New Ingredient Names and/or New Brand Names are highlighted in red.

Class: Antifungal

  • Voriconazole (Vfend®)

Class: Anemia/Renal disorders

  • Darbepoetin alfa (Aranesp®, Aranesp SureClick®)
  • Epoetin alfa (Epogen®, Procrit®)

Class: Antiemetics

  • Dolasetron mesylate (Anzemet®)
  • Fosaprepitant dimeglumine (Emend®)
  • Granisetron hydrochloride (Kytril®–IV)
  • Ondansetron hydrochloride (Zofran®)
  • Palonosetron hydrochloride (Aloxi®)

Class: Antihemophilic agent

  • Anti–inhibitor Coagulant Complex (Feiba VH Immuno®)
  • Factor IX (Rixubis)
  • Factor IX Complex (Profilnine SD®, Bebulin VH®, Proplex T®)
  • Factor IX Human (AlphaNine SD®, Mononine®)
  • Factor IX Recombinant (BeneFIX®)
  • Factor VIII Human (Alphanate®, Alphanate/VWF Complex®, Hemofil M®, Koate DVI®, Koate–HP®, Monoclate–P®)
  • Factor VIIa (e.g. NovoSeven®, NovoSeven RT®)
  • Factor VIII Recombinant (Advate®, Recombinate®, Kogenate FS®, Kogenate FS Bio–Set®, Helixate FS®, ReFacto®, Xyntha®, Advate H®, Advate L®, Advate M®, Advate SH®, Advate UH®)
  • VonWillebrand Factor Complex (Humate–P®)
  • VonWillebrand Factor / Coagulation Factor VIII Complex (Wilate®)

Class: Antipsychotics

  • Paliperidone (Invega Sustenna®)
  • Risperidone long–acting (Risperdal ConstaTM)
  • Aripiprazole (Abilify Maintena)

Class: Antiviral

  • Cidofovir (Vistide®)
  • Foscarnet sodium (Foscavir®)
  • Ganciclovir (Cytovene®–IV)
  • Ribavirin (Virazole®)

Class: Bisphosphonate

  • Denosumab (Prolia®)
  • Ibandronate (Boniva®)
  • Pamidronate disodium (Aredia®)
  • Zoledronic acid (Reclast®, Zometa®)

Class: Blood modifier

  • Filgrastim (Neupogen®)
  • Iron dextran (Dexferrum®, Infed®)
  • Iron sucrose (Venofer®)
  • Lepirudin (Refludan®)
  • Pegfilgrastim (Neulasta®)
  • Plerixafor (Mozobil®)
  • Protein C Concentrate (Ceptorin®)
  • Sargramostim (Leukine®)
  • Tbo-filgrastim (Granix)
  • Urokinase (Kinlytic®)
  • Velaglucerase alfa (VPRIV®)

Class: Botulinum toxin

  • AbobutulinumtoxinA (Dysport ®), PPA may be required
  • Incobotulinum ToxinA (Xeomin®)
  • OnabotilinumtoxinA (Botox®)
  • RimabotilinumtoxinB (MyoblocTM)

Class: Cardiovascular

  • Epoprostenol Sodium (Flolan®)
  • Iloprost (Ventavis®)
  • Nesiritide (Natrecor®)
  • Treprosinil inhalation (Tyvaso®)
  • Treprostinil injection (Remodulin®)

Class: Contraception

  • Etonogestrel (Implanon®, Nexplanon®)
  • Levonorgestrel – releasing intrauterine contraceptive system (Mirena®)
  • Medroxyprogesterone acetate (Depo–ProveraTM)

Class: Endocrine / Metabolic

  • Corticotropin (Acthar®)
  • Hydroxyprogesterone Caproate (MakenaTM)
  • Levonorgestrel (Skyla IUD)
  • Methylnaltrexone bromide (Relistor®)
  • Pegloticase (KrystexxaTM)
  • Somatostatin analog (Signifor)

Class: Enzyme replacement

  • Agalsidase beta (Fabrazyme®)
  • Alglucerase (Ceredase®)
  • Alglucosidase Alfa (Lumizyme®, Myozyme®)
  • Alpha – 1 proteinase inhibitor (Aralast®)
  • Alpha – 1 proteinase inhibitor (Prolastin®)
  • Alpha – 1 proteinase inhibitor (Zemaira®)
  • Galsulfase (Naglazyme®)
  • Idursulfase (Elaprase®)
  • Imiglucerase (Cerezyme®)
  • Laronidase (Aldurazyme®)
  • Pegademase bovine (Adagen®)
  • Taliglucerase alfa (Elelyso)

Class: Hormone

  • Histrelin acetate (Supprelin LA®)
  • Testosterone (Testopel®)
  • Thyrotropin alfa (Thyrogen®)

Class: Immune globulinsupplies.jpg

  • CMV–IVIG (human) (CytoGam®)
  • Immune Globulin Intravenous ( CarimuneNF®, Flebogamma®, Gammagard S/D®, Gammagard®, Gammaked®,Gammaplex®, Gamunex®, Octagam®, Privigen®) – PPA may be required
  • Immune globulin (Bivigam)
  • Immune globulin human (Octagam)
  • Palivizumab (Synagis®)
  • Rho(D) Immune Globulin Human (HyperRho S/D®, MICRhoGAM®, MiCRhoGAM Plus®, RhoPhylac®, Rhogam Ultra Filtered Plus®, WinRho SDF®)
  • Immune Globulin Subcutaneous (Hizentra®, Vivaglobin®) – PPA may be required

Class: Immunomodulator

  • Abatecept (Orencia®)
  • Alefacept (Amevive®)
  • Belimumab (Benlysta®)
  • Golimumab (Simponi Aria)
  • Golimimab (Simponi®), PPA may be required
  • Infliximab (Remicade®), PPA may be required
  • Interferon alfa–2b recombinant (Intron A®)
  • Interferon alfa–n3 (Alferon–N®)
  • Natalizumab (Tysabri®)
  • Peginterferon alfa–2b (SylatronTM)
  • Rituximab (Rituxan®), PPA may be required
  • Tocilizumab (Actemra®), PPA may be required
  • Ustekinumab (Stelara®)

Class: Immunosuppresive

  • Belatacept (Nulojix®)
  • Cyclosporine injection (Sandimmune®)

Class: Migraine

  • Dihydroergotamine mesylate (D.H.E. 45®)

Class: Miscellaneous

  • Aflibercept (Eylea®)
  • Antithymocyte globulin (Atgam®)
  • Basililiximab (Simulect®)
  • Betaine (Cystadane®)
  • Calcitriol (Calcijex®)
  • C1 esterase inhibitor (Berinert® , Cinryze®)
  • Canakinumab (Ilaris®)
  • Capsaicin (Qutenza®)
  • Collagenase Colistridium Histolyticum (Xiaflex®)
  • DMSO, dimethyl sulfoxide (Rimso–50®)
  • Daclizumab (Zenapax®)
  • Deferoxamine mesylate (Desferal®)
  • Ecallantide (Kalbitor®)
  • Eculizumab (Soliris®)
  • Gold sodium thiomalate (Myochrysine®)
  • Hyaluronidase ovine (Vitrase®)
  • Lymphocyte immune globulin (Thymoglobulin®)
  • Naltrexone hydrochloride (Vivitrol®)
  • Octreotide depot (Sandostatin® LAR)
  • Octreotide non depot (Sandostatin®)
  • Recombinant Hyaluronidase Human (Hylenex®)
  • Romiplostim (Nplate®)
  • Secretin, synthetic, human (ChiRhoStim®)
  • Tranexamic Acid injection (Cyklokapron®)
  • Ziconotide (Prialt®)
  • Unclassified Biologic: When filing a Drug with an unclassified HCPC code, the appropriate NDC # must be included on the claim.

Class: Opthamology

  • Ocriplasmin (Jetrea)

Class: Oncology

  • Adrucil (Fluorouracil®)
  • Aiv-afilbercept (Zaltrap)
  • Aldesleukin (Proleukin®)
  • Alemtuzumab (Campath®)
  • Amifostine crystalline (Ethyol®)
  • Arsenic trioxide (Trisenox®)
  • Asparaginase (Elspar®)
  • Asparaginase erwinia chrysanthemi (Erwinaze®)
  • Azacitidine (Vidaza®)
  • BCG Live intravesical (TheraCys®, Tice BCG®)
  • Bendamustine HCL (Treanda®)
  • Bevacizumab (Avastin®)
  • Bleomycin sulfate (Blenoxane®)
  • Bortezomib (Velcade®)
  • Brentuximab (Adcetris®)
  • Busulfan (Busulfex®)
  • Cabazitaxel (Jevtana®)
  • Carboplatin aqueous solution (Paraplatin®)
  • Carmustine (Bicnu®)
  • Carfilzomib (Kyprolis)
  • Cetuximab (Erbitux®)
  • Cisplatin (Platinol® AQ)
  • Cladribine (Leustatin®)
  • Clofarabine (Clolar®)
  • Cyclophosphamide (Cytoxan®)
  • Cytarabine liposome (DepoCyt®)
  • Dacarbazine (DTIC–DOME®)
  • Dactinomycin (Cosmegen®)
  • Daunorubicin citrate (Daunoxome®)
  • Decitabine (Dacogen®)
  • Degarelix (Firmagon®)
  • Denileukin Diftitox (Ontak®)
  • Denosumab (XgevaTM)
  • Dexrazoxane hydrochloride (Totect®, Zinecard®)
  • Docetaxel (Taxotere®)
  • Doxorubicin hydrochloride (Adriamycin®)
  • Doxorubicin hydrochloride liposome (Doxil®)
  • Epirubicin HCL (Ellence®)
  • Eribulin Mesylate (HalavenTM)
  • Etoposide (Toposar®)
  • Etoposide phosphate (Etopophos®)
  • Floxuridine (Fudr®)
  • Fludarabine phosphate (Fludara®)
  • Fluorouracil (Adrucil®, Fluorouracil®)
  • Fulvestrant (Faslodex®)
  • Gemcitabine hydrochloride (Gemzar®)
  • Gemtuzumab ozogamicin (Mylotarg®)
  • Goserelin acetate (Zoladex®)
  • Gytarabine (Cytarabine®)
  • Histrelin acetate (Vantas®)
  • Idarubicin hydrochloride (Idamycin PFS®)
  • Ifosfamide (Ifex®)
  • Irinotecan hydrochloride (Camptosar®)
  • Ipilimumab (Yervoy®)
  • Ixabepilone (Ixempra®)
  • Lanreotide acetate (Somatuline Depot®)
  • Leucovorin calcium injection
  • Levoleucovorin calcium (Fusilev®)
  • Leuprolide acetate depot (Leupron Depot®, Lupron Depot® – Pediatric, Eligard®)
  • Liposomal doxorubicin hydrochloride (Lipodox)
  • Mechlorethamine (Valchlor)
  • Mechlorethamine hydrochloride (Mustargen®)
  • Melphalan hydrochloride (Alkeran®)
  • Mesna (Mesnex®)
  • Mitomycin (Mitomycin®)
  • Mitoxantrone hydrochloride (Novantrone®)
  • Nelarabine(Arranon®)
  • Obinutuzumab (Gazyva)
  • Ofatumumab (Arzerra®)
  • Oxaliplatin (Eloxatin®)
  • Paclitaxel protein bound (Abraxane®)
  • Paclitaxel (Taxol®, OnxolTM)
  • Palifermin (Kepivance®)
  • Panitumumab (Vectibix®)
  • Pegaspargase (Oncaspar®)
  • Pemetrexed disodium (Alimta®)
  • Pentostatin (Nipent®)
  • Pertuzumab (Perjeta)
  • Porfimer sodium (Photofrin®)
  • Pralatrexate (Folotyn®)
  • Rasburicase (Elitek®)
  • Rituximab (Rituxan®)
  • Streptozocin (Zanosar®)
  • Temsirolimus (Torisel®)
  • Temozolomide (Temodar®)
  • Teniposide (Vumon®)
  • Thiotepa (Thiotepa®)
  • Topotecan hydrochloride (Hycamtin®)
  • Trastuzumab (Herceptin®)
  • Triptorelin pamoate ( Trelstar Depot®, Trelstar LA®)
  • Valrubicin (Valstar®)
  • Vinblastine sulfate (Velban®)
  • Vincristine Liposome (Marqibo)
  • Vincristine sulfate (Vincasar®)
  • Vinorelbine tartrate (Navelbine®)

Class: Ophthalmology

  • Cross-linked Hyaluronate (Gel-One)
  • Fluocinolone acetonide (Retisert®)
  • Ganciclovir (Vitrasert®)
  • Pegaptanib sodium (Macugen®)
  • Verteporfin (Visudyne®)
  • Ranibizumab (Lucentis®)

Class: Osteoarthritis

  • Hyaluronan (Orthovisc®)
  • Hylan Polymers (Synvisc®, Synvisc One®)
  • Sodium hyaluronate (Hyalgan®, SupartzTM, Euflexxa®)

Class: Respiratory

  • Alpha–1 proteinase inhibitor, Human (Glassia®)
  • Aztreonam (Cayston®)
  • Omalizumab (Xolair®), PPA may be required