Specialty Pharmacy Program
We contract with Walgreens Specialty Pharmacy to fill mail-order prescriptions for specialty drugs for Blue Cross Blue Shield of Michigan and Blue Care Network members. You can also order drugs at any contracted retail pharmacy in our network.
What are specialty drugs?
Physicians use specialty drugs to treat chronic or genetic conditions. These drugs may need special handling and monitoring. Download the Specialty Drug Program Member Guide (PDF) for commonly prescribed specialty drugs.
Are there any limitations on specialty drugs?
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 those drugs.
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. Any refill after that is 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. If your medication has a 15-day supply limit, you’ll pay your regular copay.
How should I bill for specialty drugs?
When you order specialty drugs from Walgreens Specialty Pharmacy for a Blues member, Walgreens will bill us for the medication. You'll bill us for administering the drugs to the patient.
- Physicians — Submit claims to Blue Cross Blue Shield of Michigan or Blue Care Network on the CMS-1500 form or online. Make sure to bill drugs under the medical benefit for the administration fee with an HCPCS code (J, S, 90000, etc.). To determine the availability of a specific drug, call Walgreens Specialty Pharmacy at 1-866-515-1355. You can order drugs on a member-specific basis. You'll receive your order at the office.
- Pharmacies — Retail pharmacies will continue to have the option of dispensing specialty drugs. If the patient fills their specialty drug prescription at a specialty pharmacy, you should bill under the member's prescription drug benefit. Use the 11-digit National Drug Code for specialty drugs.
For billing and reimbursement help, please contact Provider Outreach.
Questions? We can help!
To verify a member's benefit plan or get answers to your pharmacy-related questions, please contact us.