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Self-Administered Injectable Medications

BCBSNC provides coverage under its prescription drug benefit for self-administered injectable medications.

Specialty medications covered under the pharmacy benefit must be filled by a retail or mail order pharmacy participating in the Specialty medication network. These medications are marked with an asterisk (*).

Medical supervision and/or instruction may be required for certain injectable products. Some self-administered medications may be covered either by pharmacy or medical benefits and some self-administered medications are only covered by pharmacy benefits. Review our medical policy updates page for more information, or call Customer Service at the number on your BCBSNC ID card.

Pharmacy Only Benefit / Self-Administered Medications

Certain self-administered drugs are ONLY covered under the prescription drug benefit and are excluded from BCBSNC's medical benefit. While members have the freedom to self-administer these medications, they can still obtain these medications at the pharmacy and take them to their doctor's office, where they can receive training on how to self-administer them. The following self-administered medications are covered under BCBSNC's prescription drug benefit but are EXCLUDED from the medical benefit.

(This list is current as of January 2009 and is subject to change. As new self-administered medications become available, they will be added to this list as quickly as possible and excluded from the medical benefit.)

*Bravelle -PA
  Caverject -BL
*Cetrotide -BL
*Chorionic Gonadotropin - BL
  Cimzia -PA
  Edex -BL
*Enbrel -PA
*Fertinex -BL
*Follistim, Follistim AQ -BL
*Ganirelix acetate -BL
*Genotropin -PA
*Gonal-F, Gonal-F RFF -BL
*Humatrope -PA
*Humira -PA
  Imitrex -QL
*Increlex -PA
*iPlex -PA
*Kineret -PA
*Leuprolide Acetate (subcutaneous)
*Lupron (subcutaneous)
*Luveris -BL
*Menopur -BL
  Muse -BL
*Norditropin -PA
*Novarel -BL
*Nutropin -PA
*Omnitrope -PA
*Ovidrel -BL
*Pregnyl -BL
*Profasi -BL
*Raptiva -PA
*Repronex -BL
*Ribavirin (oral)
*Saizen -PA
*Serostim -PA
  Sumatriptan -QL
*Tev-Tropin -PA
*Zorbtive -PA

*Specialty drug needs to be filled at a participating Retail Specialty Pharmacy
PA - Prior approval may be required.
BL - Benefit limits may apply.
QL - Quantity limitations may apply.

Pharmacy and Medical Benefit Injectable Medications List

These injectable medications are covered under the pharmacy OR medical benefit:

  Butorphanol injection
  DDAVP injection
  Depo-Provera 150
  Depo-SubQ Provera 104
  Desmopressin injection
  Dihydroergotamine injection
  Insulins (e.g. Humulin, Novolin)
*Intron A
  Ketorolac injection
  Medroxyprogesterone for contraception
  Methotrexate 25 mg/ml
  Progesterone in oil
*Sandostatin - Not Sandostatin-LAR
  Stadol injection
  Testosterone injections - not Testopel
  Testosterone cypionate
  Testosterone propionate
  Vitamin B12 injections
  Vitamin D products
  Vitamin K products