Office-administered Specialty Drug Network

Guidelines

To use the Office-administered Specialty Pharmacy Network, providers should:

  • Complete a specialty pharmacy order form (contact vendor customer service for company specific order form).
  • Include all specified criteria with the drug order form to expedite the request.
  • Fax the completed form to the specialty pharmacy provider.
  • The specialty pharmacy provider will verify eligibility with BCBSNC and inform the provider of prior approval requirements, when applicable.
  • If necessary, complete appropriate prior approval form and fax to the specialty pharmacy provider.
  • The specialty pharmacy provider will deliver drugs to the provider's office address as listed on the order form. Orders can be placed up to seven days prior to the patient's appointment. Most orders can be delivered within 24 to 48 hours. In the event an order is significantly delayed due to manufacturer backorder, the specialty pharmacy provider will contact you.
  • Do not file a claim to BCBSNC for the drug. The specialty pharmacy provider will bill BCBSNC directly. Only submit claims for the administration of the drug.
  • Upon delivery of the medication to the office, please verify that the drug(s) and the quantity delivered matches the drug(s) and quantity ordered. Report any discrepancy immediately to the specialty pharmacy provider.
  • Members can place refill orders to be sent to a physician's office by calling the specialty pharmacy provider (member must have a valid prescription for remaining refills).

Please note: 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.