Specialty medications on our formularies
Once they are approved by the FDA, specific medications used to treat complex health conditions are designated on our formulary as “specialty medications.”
The medications on the Specialty Pharmacy Medications List that are covered under the member’s Blue Cross Blue Shield of Massachusetts pharmacy benefits must be filled using a pharmacy in our retail specialty pharmacy network. This requirement applies to all members with pharmacy benefits except those listed below who are encouraged to use our preferred specialty pharmacy network.
| Name of pharmacy: | Contact information: |
|---|---|
| Accredo Health Group | Phone: 1-800-987-4904 option 5 Fax: 1-800-391-9707 accredo.com |
| Walgreens Specialty Pharmacy |
Phone: 1-888-347-3416 Fax: 1-877-231-8302 WalgreensSpecialtyRx.com |
| CVS Specialty | Phone: 1-866-846-3096 Fax: 1-800-323-2445 cvsspecialty.com |
Fertility retail specialty pharmacies
These retail specialty pharmacies specialize in fertility medications.
| Name of pharmacy: | Contact information: |
|---|---|
| CVS Specialty |
Phone: 1-866-846-3096 Fax: 1-800-323-2445 cvsspecialty.com |
| Freedom Fertility Pharmacy | Phone: 1-866-297-9452 Fax: 1-888-660-4283 freedomfertility.com |
| Village Fertility Pharmacy | Phone: 1-877-334-1610 Fax: 1-877-334-1602 villagepharmacy.com |
Our network retail specialty pharmacies offer cost-effective specialty medications and are experienced in dispensing and monitoring these types of medications. They also offer services not available at a traditional retail pharmacy, including:
- Specialty medication administration supplies (at no additional cost)
- Delivery (overnight delivery available at no additional cost when medically necessary)
- Access to nurses and pharmacists specializing in the treatment of the member’s condition; available 24 hours a day, 7 days a week
- Educational resources for medication use, side effects, and injection administration
While commercial members are required to use the retail specialty pharmacy network, we also offer a preferred specialty pharmacy network to members of the plans listed below. These members are encouraged to use the network for these specialty medications, but are not required to do so:
- Blue MedicareRx
- Medex
- Medicare Advantage plans that include prescription coverage
- Closed, non-group plans
- Plans with a certain benefit design
If the member is taking a self-injectable specialty medication and requires education or assistance, they may be eligible for home health care services.
Federal Employee Program members are required to fill prescriptions for specialty medications at CVS CaremarkTM specialty pharmacy.
Get a list of medications and pharmacy contact information at fepblue.org.
When specialty medications on our Specialty Pharmacy Medications List are administered in your office, in an outpatient setting, or by a HIT provider, please check benefits and eligibility to learn whether the member’s medical benefit covers that service. This will help you determine if you can buy and bill for a particular medication.
In medical policy 071, Injectable Specialty Medication Coverage, you can view the list of medications that aren’t covered by our members’ medical benefits.
Federal Employee Program members
For high-cost medications that do not require pre-certification or prior approval, you can request an Advanced Benefit Determination to find out the member’s medical benefits for the medication before you administer it.
Fax in your written request, along with relevant medical record documentation, to 1-888-282-1315. You must write "Advanced Benefit Determination" on the front of your cover page.
Certain self-injectable drugs will be covered only when dispensed by a pharmacy under the pharmacy benefit, and covered once per lifetime per therapeutic category of drugs when dispensed by a non-pharmacy benefit provider. This benefit limitation does not apply when Medicare Part B is primary. Be sure to submit claims for drugs dispensed by a pharmacy to Caremark™, the Federal Employee Program pharmacy benefit manager.
For details, visit www.caremark.com or call 1-888-346-3731 for the list of medications restricted under this benefit.
