View specialty drug information for our Affordable Care Act (ACA) Business Advantage product. The specialty drug information listed here is not applicable for Business Advantage.
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, CVS Specialty, to have coverage for their specialty drugs. CVS Specialty is a division of CVS Health, an independent company that provides specialty pharmacy services on behalf of BlueChoice®. To contact CVS Specialty, call 800-237-2767. CVS Specialty 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 benefits booklet. Or talk with your employer’s benefits department. You can also log in to My Health Toolkit®. There you’ll find personal information about your prescription drug coverage.