Drugs on the specialty drug list are used to treat complex or chronic conditions. This includes cancer, rheumatoid arthritis, multiple sclerosis and hepatitis, among others. Some specialty drugs can either be taken by mouth or injected by the patient themselves, or they may be given/administered in a doctor’s office. Benefits may require certain specialty drugs be administered/given in a specific site of service. Specialty drugs may need special handling and refrigeration. Taking them sometimes requires careful monitoring.
Most BlueChoice HealthPlan members are required to use our preferred specialty pharmacy, Optum Specialty Pharmacy, to have coverage for their specialty drugs. Optum Specialty Pharmacy is a specialty pharmacy service provided by OptumRx, an independent company that provides pharmacy benefit management services on behalf of BlueChoice®. To contact Optum Specialty Pharmacy, call 877-259-9428. Optum Specialty Pharmacy doesn't have to fill specialty drugs administered in a doctor's office.
Specialty Medical Benefit Drug Coverage
Some members are subject to separate management programs for specialty drugs that are covered under their medical benefits.
- Prior Authorization: Some medical (injectable/infusible) specialty drugs require prior authorization. Learn how the Medical Prior Authorization program works and which drugs are included.
- Self-Administered Drugs: Certain self-administered specialty drugs are only covered under the pharmacy benefit. Learn how the Self-Administered Drug program works and which drugs are included.
- Site of Care: Some infused specialty medications must be administered at home or at an infusion suite. Learn more about the Site of Care program and which drugs are included.
Not sure how your health plan covers specialty drugs? Check your company's benefits booklet. Your employees can also log in to My Health Toolkit®. There they will find personal information about their prescription drug coverage.