Process Reminders for Self-Administered Drugs

August 15, 2012

For those medications that are self-administered, Blue Cross and Blue Shield of Oklahoma (BCBSOK) members are required to use their pharmacy benefit and acquire the medication through a pharmacy provider. Please note that self-administered drugs can include oral, patch and injectable products.

To help you determine the correct path for medication fulfillment and ensure that the correct benefit is applied, please refer to the Specialty Pharmacy Program Drug List – it identifies those drugs that are approved for self-administration and therefore covered under the patient’s pharmacy benefit.

In January 2013, BCBSOK is planning to implement a system edit that will deny services submitted on professional claims for self-administered drugs that are covered under the member’s prescription drug benefit. For your patients to receive benefit coverage, the covered self-administered drugs must be provided under their pharmacy benefit and not dispensed through the physician’s office.

As a reminder, Specialty Pharmacy is the preferred specialty pharmacy for most BCBSOK members. With a full inventory of specialty medications in stock and pharmacists available by phone 24/7, Specialty Pharmacy also provides alerts for patient non-adherence issues, coordination of medication refills, information on patient assistance organizations and other support services.

To obtain specialty medications through the Specialty Pharmacy Program, follow these steps:

  1. Collect Patient and Insurance Information
    Use the Specialty Pharmacy fax form or your own prescription form, along with your office’s fax cover sheet. Be sure to include the physician’s signature and any clinical data that may support the approval process.
  2. Fax Signed Forms to 866-203-6010
    Specialty Pharmacy’s team of pharmacists and benefit specialists will handle the details, from checking eligibility to coordinating delivery.

Specialty Pharmacy Program provides safe and efficient delivery of specialty medications and integrated management across medical and pharmacy benefits. As a service to your patients, Specialty Pharmacy can deliver those drugs that are approved for self-administration directly to the patient’s home or alternate location. Please note that Specialty Pharmacy is also available for those specialty medications that are covered under the member’s medical benefit.

For more information, visit the Pharmacy Program section.

The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Physicians are instructed to exercise their own medical judgment. Pharmacy benefits and limits are subject to the terms set forth in the member’s certificate of coverage which may vary from the limits set forth above. The listing of any particular drug or classification of drugs is not a guarantee of benefits. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.