bcbs Specialty Pharmacy: Options and Programs for Specialty Medications

Blue Cross Blue Shield (BCBS) offers a range of specialty pharmacy options and programs to help manage specialty medications.

BCBS has partnered with Optum, a leading pharmacy benefit manager, to provide specialty pharmacy services to its members.

Members can access specialty medications through a network of over 70,000 pharmacies nationwide, including retail pharmacies and specialty pharmacies.

Some BCBS plans offer a home delivery option for specialty medications, which can be convenient for members who have mobility issues or prefer not to visit a pharmacy in person.

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If you have a condition that requires specialty medications, you're in luck because BCBSKS offers a Specialty Pharmacy Program. This program benefits members with conditions requiring specialty medications, which are generally high-cost treatments for complex conditions.

To be eligible for benefits, your prescription drug benefit may require you to use Accredo or Prime Therapeutics Pharmacy. You can enroll and learn more at the Specialty Pharmacy Program website.

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Accredo and Prime Therapeutics Pharmacy have health care experts available 24/7 to assist members and providers. You can request refills through your patient portal and learn more about your medication and the condition it's treating.

If you have questions about your specialty pharmacy benefit, please call the phone number on your identification card. The process can be started by either you or your provider, and once you're enrolled, the provider will send the prescription to the designated pharmacy.

Here are some specialty pharmacies that you can consider:

BCBSKS will notify members who have conditions treated with specialty medications about the Specialty Pharmacy Program. Our goal is to help our members get the best results from their prescribed medication therapy. Improving compliance will result in better treatment outcomes and reduce overall health care costs.

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Your prescription drug benefit may require you to obtain specialty hemophilia medications through your pharmacy benefit. This applies to members who use the ResultsRx formulary, as well as groups who opt into this benefit design.

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If you have questions about your specialty pharmacy benefit, as it pertains to hemophilia drugs, please call the phone number on your identification card.

You can obtain specialty hemophilia medications through providers such as Dandurand Wellness, Innovative Infusion Specialists, Red Chip of Nevada Pharmacy, and Option Care Health.

Specialty medications generally meet one or more of the following characteristics: high cost due to treatment of complex conditions, self-injected, inhaled or taken orally, special handling or storage, strict compliance and patient support, additional education and support required from a health care professional, usually not stocked at retail pharmacies, and may only be available through limited distribution arrangements.

Accredo and Prime Therapeutics Pharmacy are designated specialty pharmacies for certain members. To order through these pharmacies, the process can be started by either you or your provider.

Accredo contact information includes a phone number (833) 721-1620, fax number (888) 302-1028, and address (P.O. Box 954041, St Louis, MO 63195). Prime Therapeutics Pharmacy contact information includes a phone number (866) 554-2673, fax number (866) 364-2673, and address (P.O. Box 621988, Orlando, FL 32862).

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The following is a list of specialty pharmacies for members with conditions treated with specialty medications:

Innovative Infusion Specialists

Red Chip of Nevada Pharmacy

Option Care Health

BCBSKS will notify members who have conditions treated with specialty medications about the Specialty Pharmacy Program.

If you need a medication that requires prior authorization, you'll need to contact BCBS Specialty Pharmacy to initiate the process.

BCBS Specialty Pharmacy has a dedicated team that will review your request and make a decision within 24-48 hours.

If your request is approved, the medication will be shipped to you within 2-3 business days.

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Prior authorization requests can be submitted electronically or by phone, with most health plans accepting electronic submissions.

The average time to process a prior authorization request is 2-3 business days, but can take up to 30 days in some cases.

Healthcare providers can use online portals or mobile apps to submit prior authorization requests, making the process more efficient.

Some health plans require providers to submit prior authorization requests through a specific portal or system, such as Availity or Change Healthcare.

Providers can also use third-party vendors to help with the prior authorization process, which can streamline tasks and reduce administrative burdens.

To address provider concerns, a six-month continuity of care program was offered, allowing providers to keep using the old process while they adjust to the new system.

This transition period has been instrumental in helping providers understand the new process and alleviate their concerns. Meetings have been held with providers to better understand their concerns and help them grasp how the new system works.

The program has also allowed providers to continue using their current processes with minimal disruption, as long as they are part of the in-network specialty pharmacy network. This network has expanded to include two large hospital systems and six infusion centers.

For providers who don't want to become specialty pharmacies, "dispensing provider agreements" are available. This option allows them to continue buying and billing for specialty drugs at the same rates as in-network specialty pharmacies.

To make this option more accessible, a software solution has been found that works for smaller providers, and the company is paying for it. This has removed a significant barrier for many providers.

Dozens of provider groups are currently in talks with the company about this option, with many expected to sign on by July 1. The company started with larger groups but plans to roll out the option across the state.

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BCBS Specialty Pharmacy offers a range of programs and services designed to make managing specialty medications easier and more affordable.

The Prior Authorization program helps patients get the medications they need by reviewing their medical history and current treatments to ensure they're getting the right care.

BCBS Specialty Pharmacy also offers a patient assistance program that provides financial assistance to eligible patients who are struggling to pay for their medications.

The Specialty Pharmacy Network program connects patients with a network of pharmacies that specialize in handling complex medications, making it easier to find a pharmacy near you.

With the BCBS Specialty Pharmacy program, patients can expect to receive their medications quickly and efficiently, often within 24-48 hours of ordering.

The program's dedicated customer service team is available to answer questions and provide support to patients and their families.

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