Specialty Pharmacy Program Changes - effective 7/1/2011
Most members who take specialty medications have complex chronic conditions. In order to assist these members and meet their unique medical needs, Blue Cross and Blue Shield of North Carolina (BCBSNC) is creating a new specialty pharmacy network for the medical and pharmacy benefit effective July 1, 2011 for commercial business (Medicare Part D is not impacted). This network will consist of providers that meet rigorous criteria, including:
- Available nursing or pharmacist services 24 hours a day, 7 days a week, 365 days a year;
- Disease specific initial and ongoing evaluations, monitoring of medication adherence, counseling, and documented interventions; and
- Specialty pharmacy quality accreditation (URAC), or accreditation in process.
As you are aware, specialty medications can at times be received through a member's MEDICAL and / or PHARMACY benefits. The following grid shows the network options available to underwritten versus ASO groups under the different benefits:
|100 - 249 Members||250+ Members|
|Medical||New Specialty Pharmacy Network||New Specialty Pharmacy Network||New Specialty Pharmacy Network|
|Pharmacy||New Specialty Pharmacy Network||New Specialty Pharmacy Network||Current Medco Network OR Preferred ASO Pharmacy (CuraScript)|
As of 7/1/11, all MEDICAL specialty pharmacy benefits will be through the newly contracted providers. NOTE: this change does NOT affect physician practices that bill specialty pharmacy medications directly to BCBSNC (i.e.: buy and bill). Current Contracted Specialty Pharmacies under the new Specialty Pharmacy Network:
|Accredo||Biologics||BioPlus Specialty Pharmacy|
|CuraScript||CVS Caremark||Drugco Health|
|Kerr Health||Long's Drugs||Mast Pharmacy|
|MedPro Rx||US Bioservices||Walgreens Specialty Pharmacy|
The PHARMACY benefits as of 7/1/11 will be through this same network, except that ASO 250+ groups will have an option: they can either stay with the Medco pharmacy network that exists today, or they can select the preferred specialty pharmacy provider - CuraScript.
CuraScript Specialty Pharmacy has contracted with BCBSNC to become part of its new Specialty Pharmacy Provider Network. In addition, CuraScript will be the exclusive specialty pharmacy for certain self-funded employer group health benefit plans (ASO groups) administered by Blue Cross and Blue Shield of North Carolina. This network change is effective July 1, 2011.
It is important for all providers rendering pharmacy benefits via the BCBSNC Specialty Pharmacy Network to very benefits prior to rendering services; some ASO groups may have not have selected CuraScript as their Specialty Pharmacy provider or provide pharmacy coverage to its members.
Further details regarding the new BCBSNC Specialty Pharmacy Network can be accessed on the BCBSNC Provider Portal external site at: http://www.bcbsnc.com/content/providers/injectable-drugs/available.htm. You can also submit questions and request for information to Specialty.Pharmacy@bcbsnc.com.