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What are specialty drugs?

Who is this for?

Michigan Health Insurance – Customer Service – Pharmacy

If your doctor has prescribed a specialty drug, this information explains what makes specialty drugs different and how to order them.

When you have a chronic or difficult health condition, like multiple sclerosis or rheumatoid arthritis, you may need specialty drugs. Here’s what you need to know about these medications if you have prescription drug coverage through Blue Cross Blue Shield of Michigan or Blue Care Network.

What makes specialty drugs different?

They typically require special handling, administration or monitoring. It’s also more likely they’ll need special approval to order, and you may have to order them through a specialty pharmacy.

How do I know if the medication my doctor prescribed is a specialty drug?

Look in the Specialty Drug Program Member Guide (PDF). It has a list of specialty drugs, plus more information about them.

Tip: Not sure how to read a drug list (also called a formulary)? This article will help:"How do I know if my plan covers my prescription drug?"

What does "PA" mean after the name of the specialty drug my doctor prescribed?

It stands for “prior authorization,” which means your insurance company needs to review why a drug has been prescribed before agreeing to pay for it. If you don’t get prior authorization, the medication may cost you more, or it may not be covered at all.

What does "LD" mean after the name of the specialty drug my doctor prescribed?

Some specialty drugs are more special than others. “LD” stands for “limited distribution.” The drug can only be ordered from Accredo Specialty Pharmacy, which is part of Express Scripts®, an independent company that provides pharmacy services for Blue Cross Blue Shield of Michigan and Blue Care Network.

Where do I get specialty drugs?

  • Mail order through Walgreens Specialty Pharmacy. This is the easiest way to get your specialty drugs. The form and instructions are in the Specialty Drug Program Member Guide (PDF).
  • Order through your regular retail pharmacy. Not all pharmacies fill prescriptions for specialty drugs, so check first.
  • Limited Distribution drugs must be ordered through the Accredo Specialty Pharmacy. Call 1-800-803-2523.

Can I get a 90-day supply of specialty drugs like my other medication?

If your prescription drug coverage is through Blue Care Network, you can only order a 30-day supply of specialty drugs. If your prescription drug coverage is through Blue Cross Blue Shield of Michigan, you may be able to order a 90-day supply. Check your plan details to be sure, or contact us and we'll help.

We have a specialty drug limitation program that handles certain medications. Take a look at our 15-Day Specialty Drug Limitation Program (PDF) for a list of drugs in the program.

If you’re a Blue Cross Blue Shield of Michigan member, you'll have a 15-day supply limit the first time you fill your prescription under the limitation program. Each of your refills after that will be eligible for a 30-day supply.

If you’re a Blue Care Network member, you’ll have a 15-day supply limit every time you fill your prescription under the limitation program. If your medication has a 15-day supply limit, you’ll pay half of your regular copayment.

Tip: Will you need your specialty drug prescription filled while traveling outside of Michigan? Here is a list of out of state specialty drug retail pharmacies (PDF).

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