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

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