Specialty Pharmacy Program
We contract with Walgreens Specialty Pharmacy to fill mail order prescriptions for specialty drugs for BCBSM and BCN members. Specialty drugs can also be filled at any contracted retail pharmacy in our network.
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.
15-Day Specialty Drug Limitation Program (PDF) – This program targets highly potent specialty drugs that have an increased rate of adverse reactions. It applies only to members trying the drugs for the first time. Members are charged half their copayment for the 15-day supply. Once a 15-day supply has been filled, members can obtain a 30-day supply for their regular copayment amount. All specialty drugs are limited to no more than a 30-day supply.
How should I bill for specialty drugs?
When you order specialty drugs from Walgreens Specialty Pharmacy for a patient with BCBSM or BCN medical-surgical benefits, Walgreens Specialty Pharmacy 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 Walgreens Specialty Pharmacy.
- 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.