Your plan for better healthSM1
Search

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 Retail specialty drug 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.)

Brand Name Ingredient Name Dosage Form
*Actimmune interferon gamma-1b Injection
 Apokyn apomorphine hydrochloride Injection
*Arixtra fondaparinux sodium Injection
*Avonex interferon beta-1a Injection
*Betaseron interferon beta-1b Injection
*Bravelle -PA urofollitropin Injection
 Byetta exenatide Injection
 Calcimar calcitonin Injection
 Caverject -BL alprostadil Injection
*Cetrotide -BL cetrorelix acetate Injection
*Chorionic Gonadotropin -BL chorionic gonadotropin Injection
 Cimzia -PA certolizumab pegol Injection
*Copaxone glatiramer acetate Injection
*Copegus ribavirin Tablet
 Edex -BL alprostadil Injection
*Enbrel -PA etanercept Injection
 Exjade deferasirox Tablet
*Fertinex -BL urofollitropin Injection
*Follistim, Follistim AQ -BL follitropin beta Injection
*Forteo teriparatide Injection
*Fragmin dalteparin Injection
*Fuzeon enfuvirtide Injection
*Ganirelix -BL ganirelix acetate Injection
*Genotropin -PA somatropin Injection
*Gleevec imatinib Tablet
*Gonal-F, Gonal-F RFF -BL follitropin alpha Injection
*Humatrope -PA somatropin Injection
*Humira -PA adalimumab Injection
 Imitrex -QL sumatriptan Injection, Tablet
*Increlex -PA mecasermin Injection
*Infergen interferon alfacon-1 Injection
*Innohep tinzaparin Injection
*iPlex -PA mecasermin rinfabate Injection
*Kineret -PA anakinra Injection
 Kuvan sapropterin Tablet
*Leuprolide Acetate (subcutaneous) leuprolide acteate Injection
*Lovenox enoxaparin Injection
*Lupron (subcutaneous) leuprolide acetate Injection
*Luveris -BL lutropin alfa Injection
*Menopur -BL menotropins Injection
 Miacalcin calcitonin Injection
 Muse -BL alprostadil Injection
*Neumega oprelvekin Injection
*Nexavar sorafenib Tablet
*Norditropin -PA somatropin Injection
*Novarel -BL chorionic gonadotropin Injection
*Nutropin -PA somatropin Injection
 NuvaRing Etonogestrel/Ethinyl Estradiol Vaginal Ring
*Omnitrope -PA somatropin Injection
 Orfadin nitisinone Capsules
*Ovidrel -BL choriogonadotropin alfa Injection
*Pegasys peginterferon alfa-2a Injection
*Peg-Intron peginterferon alfa-2b Injection
*Pregnyl -BL chorionic gonadotropin Injection
*Profasi -BL chorionic gonadotropin Injection
*Pulmozyme dornase alfa Inhalation
*Raptiva -PA efalizumab Injection
*Rebetol ribavirin Capsules
*Rebif interferon beta-1a Injection
*Repronex -BL menotropins Injection
*Revlimid lenalidomide Capsules
*Ribasphere ribavirin Capsules
*Ribavirin (oral) ribavirin Capsules
*Saizen -PA somatropin Injection
*Sensipar cinacalcet Tablet
*Serostim -PA Somatropin Injection
 Somatuline lanreotide Acetate Injection
*Sprycel dasatinib Tablet
 Somavert pegvisomant Injection
 Sumatriptan -QL sumatriptan Injection, Tablet
 Supprelin histrelin Injection
*Sutent sunitinib Tablet
 Symlin pramlintide acetate Injection
*Tarceva erlotinib Tablet
*Temodar temozolomide Capsule
*Tev-Tropin -PA somatropin Injection
*Thalomid thalidomide Capsule
*Tobi tobramycin Inhalation
*Tykerb lapatinib Capsule
*Xeloda capecitabine Tablets
*Zorbtive -PA somatropin Injection



*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:

Brand Name Ingredient Name Dosage Form
 Acthar adrenocorticotropic hormone Injection
 Phytonadione Phytonadione Injection
*Aranesp darbepoetin alfa Injection
 Butorphanol injection butorphanol tartrate Injection
 Calcijex Calcitriol Injection
 DDAVP injection desmopressin acetate Injection
 D.H.E-45 dihydroergotamine mesylate Injection
 Delatestryl testosterone enanthate Injection
 Delestrogen estradiol valerate Injection
 Depo-Estradiol estradiol cypionate Injection
 Depo-Provera 150 medroxyprogersterone acetate Injection
 Depo-SubQ Provera 104 medroxyprogesterone Injection
 Depo-Testosterone testosterone cypionate Injection
 Desmopressin injection Desmopressin Injection
 Dihydroergotamine injection dihydroergotamine Injection
*Eligard leuprolide Injection
 Epipen epinephrine Injection
 Epogen epoetin Injection
*Faslodex fulvestrant Injection
 Glucagon glucagon Injection
 Heparin heparin sodium Injection
 Insulins (e.g. Humulin, Novolin) insulin Injection
*Intron A interferon alfa-2b Injection
 Ketorolac injection ketorolac tromethamine Injection
 Kestrone estrogen Injection
*Leukine sargramostim Injection
 Medroxyprogesterone for contraception medroxyprogesterone Injection
 Methotrexate 25 mg/ml methotrexate Injection
*Neulasta pegfilgrastim Injection
*Neupogen filgrastim Injection
*Procrit epoetin alfa Injection
 Progesterone in oil progesterone Injection
*Sandostatin - Not Sandostatin-LAR octreotide acetate Injection
 Stadol injection butorphanol Injection
 Testosterone injections - not Testopel testosterone Injection
 Testosterone cypionate testosterone Injection
 Testosterone propionate testosterone Injection
 Twinject epinephrine Injection
 Vitamin B12 injections cyanocobalamin Injection
 Vitamin D products ergocalciferol Injection
 Vitamin K products phytonadione Injection
 Zemplar paricalcitol Injection



*Specialty drug needs to be filled at a participating Retail Specialty Pharmacy

top