Specialty Drug List

Medication Brand Name: The name given by the producing company.

HCPCS Code: Healthcare Common Procedure Coding System.

Medical Oncology: Medical Oncology reviews completed by Blue Cross vendor. Medical Oncology review request can be accessed through Blue e, available 24/7.

High-Cost Review: Medical high-cost drug reviews completed by Blue Cross vendor.

Medical Drug: Reviewed under the Medical Benefit.

Pharmacy Drug: Reviewed under the Pharmacy Benefit.

Site of Care (SOC): The Place of Service for Medical Infusions medical policy outlines criteria for medical necessity and administration of certain injectable medications at a hospital inpatient or outpatient facility. The initial administration of the medications included in this program may be given at the physician’s facility of choice. All subsequent administrations of the applicable medications will need to meet the program criteria.

Requires Prior Authorization: Requires prior review via MHK, Pharmacy vendor accessed through Blue e.

The Specialty Drug List is regularly updated and is subject to change based on new approvals and market / industry changes. New-to-market products and variations of those products will not be added to this list until they have been endorsed by Blue Cross NC's P&T Committee.

If you have questions about which medication a specific plan covers, please refer to the benefits book or check the prescription drug formulary. If you need to speak with someone, please call the customer service number on the back of the member's card.