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 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 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.
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 Blue Cross Blue Shield of Michigan or Blue Care Network 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 Blue Cross Blue Shield of Michigan provider consultant or BCN Provider Affairs representative.
Questions? We can help!
To verify a member's benefit plan or get answers to your pharmacy-related questions, please contact us.