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.
Look at our complete Specialty Drug List to find out which drugs are covered and which require prior authorization under the pharmacy benefit.
Specialty Drugs Billed Under the Medical Benefit
BlueChoice manages specialty drugs under the medical benefit in an effort to combat the rising costs of these drugs. Our Specialty Medical Benefit Management (SMBM) initiatives are listed below:
- Prior Authorization: Most medical (injectable/infusible) specialty drugs require prior authorization through the CVS/Caremark online prior authorization tool, Novologix, an industry-leading software system that assists in managing drugs reimbursed under the medical benefit. This tool is a web-based application available with single sign-on access through My Insurance ManagerSM. Physicians can also request PA by calling 866-284-9229, or by faxing 844-851-0882. View the Medical Prior Authorization List here.
- Self-administered Drugs: Certain self-administered drugs formerly covered under the member’s medical benefit are now only covered under their pharmacy benefit. Hematologists, oncologists, nephrologists and rheumatologists may continue to bill these drugs under the medical benefit. View the Self-Administered Drug List here.
- Site of Care: Some infused specialty medications are required to be administered in an infusion suite or in a home setting. You can view the Site of Care Drug List here.