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. 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.
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.
Blue Cross Blue Shield of Michigan members have a 15-day supply limit the first time they fill a prescription under the limitation program. Each refill after that will be eligible for a 30-day supply.
Blue Care Network members have a 15-day supply limit every time they fill a prescription under the limitation program. If the medication has a 15-day supply limit, they'll pay half of the regular copayment.
How should I bill for specialty drugs?
When you order specialty drugs from Walgreens Specialty Pharmacy for a patient with Blue Cross Blue Shield of Michigan or Blue Care Network 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 online. Make sure to bill drugs under the medical benefit for the administration fee with a HCPCS code (J, S, 90000, etc.). Include the 11-digit National Drug Code and the appropriate NDC quantity. Call Walgreens Specialty Pharmacy at 1-866-515-1355 to find out if your drug is available. 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 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 and the appropriate NDC quantity.
For billing and reimbursement assistance, please contact your Blue Cross or Blue Care Network Provider Inquiry Department.