Details on Specialty Pharmacy Program

Details on Specialty Pharmacy Program

Members with serious, chronic conditions can order certain specialty medications quickly and conveniently through the Specialty Pharmacy Program from BlueCross BlueShield of Tennessee. A special network of vendors, experienced in managing these medications and providing patient support, is available for our members and prescribing physicians.

Preferred Specialty Pharmacy Vendors
Accredo Health Group

Acro Pharmaceutical
Services

Amerita, Inc.
Phone: 1-888-239-0725
Fax: 1-866-387-1003
Phone: 1-800-906-7798
Fax: 1-877-381-3806
Phone: 1-855-778-2229
Fax: 1-877-801-1540
BioPlus Specialty Pharmacy Caremark Specialty
Pharmacy Services
CoramRx
Phone: 1-888-292-0744
Fax: 1-800-269-5493
Phone: 1-800-237-2767
Fax: 1-800-323-2445
Phone: 1-866-710-9130
Fax: 1-877-513-7847

Purchasing your specialty medications from these preferred vendors helps you maximize your health care benefits and provides a number of resources to you and your doctor.

Advantages to You

  • Patient care coordinators.
  • Educational materials.
  • Ability to call and consult with clinical pharmacists.
  • Potential savings on specialty medications.
  • Product delivery anywhere you choose.

Advantages to Your Doctor
Your doctor gains extra support services to help manage your care, such as:

  • 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 his or her office.

Covered Specialty Medications

The Specialty Pharmacy Program includes high-cost medications for chronic, serious diseases such as hepatitis C, multiple sclerosis, arthritis, hemophilia and other conditions. As noted on the 2013 Preferred Formulary and Prescription Drug List, there are two different types of Specialty Pharmacy medications: provider-administered and self-administered.

  • Provider-Administered Specialty Medications - These specialty medications are ordered by your doctor and administered in an office or outpatient setting.
  • Self-Administered Specialty Medications - You administer these medications to yourself. After your provider prescribes one of these medications, you should order it from one of BlueCross BlueShield of Tennessee's preferred specialty pharmacy vendors (listed above).

How to Order Specialty Medications

  • Check your Evidence of Coverage or call the Member Service number on your ID card to find out how your plan covers specialty medications.
  • Make sure your specialty medication is on the 2013 Preferred Formulary and Prescription Drug List.
  • Have your doctor obtain prior authorization if required (see the list below or check the 2013 Preferred Formulary and Prescription Drug List).
  • Have your doctor fill out the Specialty Pharmacy Prescription form. Print the Prescription Form.
  • Collect your prescription information and member ID card.
  • Call, or have your doctor call, one of the preferred specialty pharmacy vendors listed above to order your medication.

Prior Authorization for Specialty Medications

Some specialty medications require prior authorization. Your doctor should check the 2013 Preferred Formulary and Prescription Drug List and obtain prior authorization before administering or prescribing these medications.

How Specialty Medications are Covered

Coverage of these medications is determined by your benefit plan.

  • Provider-administered specialty medications are subject to a copay and will generally be covered by your BlueCross BlueShield of Tennessee medical benefit.
  • Self-administered specialty medications also require a copay and will generally be covered under your BlueCross BlueShield of Tennessee prescription drug benefit. Check your Evidence of Coverage for more information.

If you do not have prescription drug coverage through BlueCross BlueShield of Tennessee, self-administered medications will not be covered by your BlueCross BlueShield of Tennessee medical benefit. If you have prescription drug coverage through another insurer, check with your employer or plan administrator to determine your coverage level for self-administered medications.