888-765-5400Need Specialty Drugs? – Blue Has You Covered
The use of specialty medications has increased significantly over the last few years. In order to ensure that these specialty medications continue to be affordable to its members, Blue Cross Blue Shield of NC contracted with a network of pharmacies dedicated to offering lower pricing on specialty drugs. By implementing a specialty pharmacy network, BCBSNC is working to see that the cost of prescription drugs remain affordable.
Specialty medications are those medications that are used for chronic diseases such as Multiple Sclerosis and Rheumatoid Arthritis. What qualifies a specific medication or therapy to be classified as a specialty drug is not clearly defined, but there are some parameters. The following factors help determine if a pharmaceutical is considered a specialty medication: the medication requires special handling; the medication has limited distribution and can only be filled at certain pharmacies; the medication treats a rare disease; the medication requires ongoing clinical assessment and monitoring of side effects. See a list of some specialty medications.
Because these drugs are in the “specialty” category, they are typically high-cost medications, ranging anywhere from $6000 to $350,000 per patient, per year. Most of these drugs are made to be injected and many of them require special handling and shipping. Still, these drugs are of utmost importance to the patients in need of them, and that is why Blue Cross Blue Shield of North Carolina established the specialty pharmacy network. With this network, there may be a limited number of pharmacies dispensing these medications and some pharmacies may choose not to participate in the specialty drug network. If you require one of these specialty drugs, you will need to transfer your prescription to a participating local pharmacy or mail order pharmacy.
By limiting the network, the cost of the specialty medications remain more affordable; however, if you fill your specialty medications at a retail pharmacy, you must use one of the pharmacies participating in this network in order for your prescriptions to be covered. All specialty pharmacies within this network offer next day delivery with a valid prescription or prescription transfer and refills can take place after 75% of the prescription is used, except in the instance of controlled substances. Members can contact their specialty pharmacy directly to set up a new prescription and that process usually takes between 2 and 4 business days.
Blue Cross Blue Shield of North Carolina is committed to making sure you have the prescription drug coverage you need at a cost you can afford. To determine whether any of the medications you are currently taking are considered “specialty drugs,” visit the Find a Drug link or get a quote for your Blue Cross Blue Shield of NC health plan.
For more information on Blue Cross Blue Shield of North Carolina health insurance coverage, the Marketplace and healthcare gov to apply for your subsidy, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents. Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.