Specialty Rx

We know that specialty pharmaceuticals may require special handling or storage and are expensive to carry in your office. As the demand for high-cost specialty medications becomes higher, physicians are struggling to manage the costs associated with their increased use.

The Horizon BCBS Specialty Pharmaceutical Program helps physicians conveniently obtain medications they need for their patients. Horizon Blue Cross Blue Shield contracted with specialty pharmaceutical providers that can directly provide your office with specialty medications.

Specialty pharmaceuticals are typically used to treat conditions such as:

• Adenosine Deaminase Deficiency.
• Allergic Asthma
• Alpha-1 Proteinase Inhibitor Deficiency
• Anemia
• Crohn’s Disease
• Cytomegalovirus
• Fabry’s Disease
• Gaucher Disease
• Hypercalcemia of Malignancy
• Neutropenia
• Prostate Cancer
• Psoriasis
• Pulmonary Hypertension
• Respiratory Syncytial Virus
• Rheumatoid Arthritis

The Horizon BCBS Specialty Pharmaceutical Program supports your treatment goals while enhancing the quality of pharmaceutical care, service coordination and clinical outcomes.

Members who use specialty pharmaceuticals have unique needs relating to the management of their diseases and the therapies associated with them.

To assist members who are taking a specialty pharmaceutical, Horizon BCBS has contracted with pharmacies that specialize in these therapies. In addition to a high level of service, drug-/disease-specific education and support, these pharmacies provide:

• Personal attention from a pharmacist-led team to provide condition-specific education, medication administration instruction and advice to help manage therapy.
• Claims assistance to help determine individual coverage and file the necessary paperwork.
• Easy access to pharmacists and other health experts 24 hours a day, seven days a week.
• Informative condition-specific materials.
• Easy ordering with a dedicated toll-free number.
• Convenient delivery to the location of choice (e.g., member’s home, physician’s office, vacation spot, etc.).
• Helpful follow-up care calls to remind members when it’s time to refill a prescription, to check on therapy progress and answer any questions members may have.

Horizon BCBS members who use certain specialty pharmaceuticals and want to minimize their cost-sharing by using in-network pharmacies, are required to obtain the prescription drugs from a participating specialty pharmacy listed below.

Participating Specialty Pharmacies

Please note:

• Other prescription drugs not on the Specialty Pharmaceutical List should still be obtained through participating retail or mail-service pharmacies under your prescription drug plan to obtain in-network benefits.
• Specialty pharmaceuticals may be subject to medical necessity review.
• The list of specialty pharmaceutical drugs may be subject to change and may be updated periodically.
• Some self-funded employer groups have chosen to allow AllianceRx Walgreens Prime Specialty Pharmacy to exclusively dispense specialty pharmaceuticals on an in-network basis. Refer to your policy documents or contact Pharmacy Member Services at the toll-free number on the back of your Horizon BCBSNJ ID card if you have any questions.

Not all plans cover infertility benefits. Refer to your policy documents or contact Pharmacy Member Services at the toll-free number on the back of your Horizon BCBS ID card for coverage information.