For Providers: What Do I Need to Know About Specialty Drugs?

Specialty drugs are prescription medications that require special handling, administration or monitoring. They treat complex and chronic conditions.

At Blue Cross Blue Shield of Michigan and Blue Care Network, we've contracted with AllianceRx Walgreens Prime to handle mail-order prescriptions for specialty drugs. These drugs can also be ordered at any contracted retail pharmacy in our network.

To determine the availability of a specific specialty drug, you can call AllianceRx Walgreens Prime at 1-866-515-1355.

Limitations

We limit certain specialty drugs to a 15-day supply limit to reduce copays and drug waste.

Our specialty drug limitation program outlines which medications have limitations. For a list, take a look at our 15-Day Specialty Drug Limitation Program (PDF).

Provider billing

Providers will need to submit a claim to us 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.). You can order drugs on a member-specific basis. You'll receive your order at your office.

Pharmacy billing 

Retail pharmacies will continue to have the option of dispensing specialty drugs. If a patient fills their specialty drug prescription at your specialty pharmacy, you should bill under the member's prescription drug benefit.

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Related forms and documents

15-Day Specialty Drug Limitation Program (PDF)
Specialty Drug Program Member Guide (PDF)
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