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Blue Choice

Specialty Drugs

BlueChoice HealthPlan provides coverage for specialty drugs under both the pharmacy and medical benefit. Members must fill oral and self-injectable medications through our preferred specialty pharmacy, CVS/specialty, to have coverage under their pharmacy benefit. CVS/specialty is a division of CVS Health, an independent company that provides specialty pharmacy services on behalf of BlueChoice®. To get a patient set up, please contact CVS/specialty at 800-237-2767. Or providers can fax a prescription to 800-323-2445.

For specialty drugs billed under the pharmacy benefit, CVS/specialty will review prior authorization requests. Please contact them at 800-237-2767. Beginning June 1, 2016, requests for prior authorization for specialty drugs be billed under the medical benefit should be made through Novologix, CVS/caremark's medical prior authorization system. Providers can get to Novologix with single sign-on access through My Insurance ManagerSM.

Drugs that are billed under the medical benefit as “buy and bill” do not require purchase through CVS/specialty.  Generally, the member has a specialty pharmacy copayment for every dose you administer in your office. The member has a monthly specialty pharmacy copayment for oral or self-injectable drugs. Please consult the member's Schedule of Benefits for copayment amounts.

Look at our complete list of Specialty Drug List to find out which drugs are covered and which require prior authorization.

Go back to the Prescription Drug Information page.