Providers who have patients with serious, chronic conditions can order certain specialty medications quickly and conveniently through the Specialty Pharmacy Program from BlueCross BlueShield of Tennessee.

The List of Specialty Pharmacy Medications  includes high-cost drugs for hepatitis C, multiple sclerosis, arthritis, hemophilia and other diseases.

Preferred Specialty Pharmacy Vendors

BlueCross BlueShield of Tennessee uses vendors that are experts in specialty medications. To order drugs from these specialty pharmacies, print the Specialty Pharmacy Prescription Form   and fax to one of these preferred vendors:

Purchasing specialty medications from these preferred vendors provides a number of resources to you and your patients:

Advantages to You

• Compliance management programs to help optimize treatment.
• Disease management programs to actively monitor and manage complex drug regimens.
• Patient care coordinators.
• Ability to consult with clinical pharmacists.
• Reduced need to maintain an inventory of specialty medications.
• Product delivery to your office or patients’ homes.

Advantages to Your Patients

• Patient care coordinators.
• Educational materials.
• Ability to call and consult with clinical pharmacists.
• Potential savings on specialty medications.
• Product delivery to their homes or your office.

How Specialty Medications are Covered

As indicated on the List of Specialty Pharmacy Medications  , there are two different types of Specialty Pharmacy medications: provider-administered and self-administered.

• Provider-Administered specialty medications are ordered by a provider and administered in an office or outpatient setting. These specialty medications are subject to a copay and will generally be covered under patients’ BlueCross BlueShield of Tennessee medical benefits.

• Self-Administered specialty medications are administered by patients to themselves. A provider prescribes one of these medications, and patients purchase their medications from one of BlueCross BlueShield of Tennessee’s preferred specialty pharmacy vendors (listed above). Self-administered specialty medications are subject to a copay and will generally be covered under patients’ BlueCross BlueShield of Tennessee prescription drug benefits.

If a patient does not have a prescription drug benefit through BlueCross BlueShield of Tennessee, self-administered medications are not covered. A patient may have prescription drug benefits through another insurer. If so, he or she should check with the group administrator or employer to determine the coverage level for specialty medications.

Important note on submitting claims for specialty medications:

• Providers should only submit claims for medications that are considered provider-administered. Under most plans, claims submitted for medications that are considered self-administered will be denied.
  
• Patients with prescription drug benefits through BlueCross BlueShield of Tennessee need to obtain self-administered specialty medications through one of the preferred specialty pharmacy vendors not through their providers.

Prior Authorization for Specialty Medications

The list of medications requiring prior authorization is subject to change at any time. Check the List of Specialty Pharmacy Medications  or call Provider Service at 1-800-924-7141 for the most up-to-date information.