What do I need to know about specialty drugs?

Who is this for?

Michigan Health Insurance – Customer Service – Pharmacy

Blue Cross Blue Shield of Michigan and Blue Care Network members under age 65 with prescription drug coverage.

When you're fighting cancer or dealing with a difficult condition like multiple sclerosis, you may need something we call specialty drugs.

They typically require special handling, administration or monitoring. It's also likely they'll need prior approval before your plan will help pay for them. Some can only be filled by a specialty pharmacy. 

How to get information about specialty drugs

Details about specialty drugs aren't just available to your doctor and pharmacists. They're available to you too, three different ways.

Log in to your member account on our website or the Blue Cross mobile app.

  • Go to the prescription section under My Coverage
  • On our website, select Price a Drug
  • On the app, go to Express Scripts, and select Price a Medication from the main screen; you may have to scroll down a little

You'll need the name of the drug. It's helpful to know the dosage your doctor prescribed.

Look on a drug list.

Drug lists can't tell you the price of a prescription. But you can see if a prescription is considered a specialty drug, and whether it needs prior authorization before your plan will help pay for it.

Find your plan's drug list.

If you already know your prescription is a specialty drug, you can get more information about it in the Specialty Drug Program Rx Benefit Member Guide (PDF). It also tells you where and how to fill your prescription.

Call us.

We can answer questions about a specialty drug during business hours. Contact us and we'll help.

Filling a specialty drug prescription

Most specialty drugs can be filled at a retail pharmacy or by mail order through Alliance Rx Walgreens Prime Specialty Pharmacy. Some specialty drugs can only be ordered by phone and delivered by mail from one pharmacy.

If your doctor didn't send in the prescription for you, use the Specialty Drug Program Rx Benefit Member Guide (PDF) to look up your drug and find out where and how to fill your prescription. 

Traveling outside Michigan in the U.S.? If you fill your prescription at a retail pharmacy, the Out-of-State Retail Specialty Network (PDF) will help you find a pharmacy.

Limits on specialty drugs

Whether you get them at a pharmacy or by mail order, Blue Care Network HMO plans limit most specialty drugs to a 30-day supply. Some Blue Cross Blue Shield of Michigan PPO plans do, too.

Some drugs are limited to a 15-day supply. They're listed on the 15-day Specialty Drug Limitation Program (PDF). If you have a copay for your prescription, you only pay half of it for these drugs.