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Learn moreBlue Care Network
Specialty Pharmacy Program
We've contracted with Option Care to fill mail order prescriptions for specialty drugs for BCBSM and BCN members.
What are specialty drugs?
Specialty drugs are used to treat specific chronic or genetic conditions that may require special handling, administration and monitoring. Download the Specialty Drug List (PDF) for commonly prescribed specialty drugs.
How should I bill for specialty drugs?
When you order specialty drugs from Option Care for a patient with BCBSM or BCN medical-surgical benefits, Option Care will bill us for the medication and you will need to bill us for administering the drugs under the member's benefits.
- Physicians: Submit claims to BCBSM or BCN on the CMS-1500 form or electronically. Drugs billed under the medical benefit for the administration fee are billed with a HCPCS code (J, S, 90000, etc.). Medications listed on the BCBSM/BCN specialty product list (PDF) may be ordered directly from Option Care.
- Pharmacies: Retail pharmacies will continue to have the option of dispensing specialty pharmaceuticals. Specialty Drugs filled at a retail pharmacy should be billed under the member's prescription drug benefit. Use the 11-digit National Drug Code for specialty drugs.
For billing and reimbursement assistance, please contact your BCBSM provider consultant or BCN Provider Affairs representative.
