Specialty Pharmacy Program
This program helps deliver specialty medications directly to physicians or to members that include injectable and infused therapies used to treat complex medical conditions such as growth hormone deficiency, hepatitis C, immune deficiency, hemophilia, multiple sclerosis and rheumatoid arthritis. Due to special storage requirements and high cost, injectable specialty medications may not be readily available at local pharmacies.
Blue Cross and Blue Shield of Illinois (BCBSIL) contracts with the select specialty pharmacies listed below to ensure availability of specialty medications for our members.* The benefits of obtaining self-injectable specialty medications from these preferred specialty pharmacies include:
- Integrated coordination of coverage between the member, physician and BCBSIL
- No up-front acquisition cost to physicians for non-self-administered/office-based specialty medications
- Convenient delivery of medication to physician's office or member's address
- Injection supplies with every shipment, including alcohol swabs, needles and syringes
- Automatic coordination of refills
- Patient education materials and therapy starter kits from drug manufacturers
- 24-hour hotline staffed nurse and/or pharmacist to call with medication and injection questions
*The relationship between BCBSIL and the specialty pharmacies is that of independent contractors.
Note: Injectable coverage is based on the member's benefit. Prior Authorization or Predetermination approval still applies to specific medications that fall under clinical review. In accordance with their benefits, some members may be required to use a specific preferred specialty pharmacy. Please call the number on the member’s ID card to verify coverage, or for further assistance or clarification on the member’s benefits.
Accredo is a preferred vendor for hemophilia (factor) products. To contact Accredo regarding hemophilia (factor) products, call 877-ACCREDO (222-7336). Referral information may be faxed to Accredo at 800-330-0756.
Bleeding Clotting Disorder Institute (BCDI) is a preferred vendor for hemophilia (factor) products. To contact BCDI regarding hemophilia products, call 877-335-2234. For more information, visit their website at www.ilbcdi.org.
Coram is an outpatient and home infusion provider. To contact Coram, call 866-899-1661 or fax the Referral Form to 866-843-3221.
Coram is an independently contracted third party vendor and is solely responsible for its services and products.
HMO Illinois® and Blue Advantage HMOSM members with prescription drug benefits administered through Prime Therapeutics must fill their specialty medication prescriptions at a pharmacy within the specialty pharmacy network for pharmacy benefit coverage consideration.
Northwestern is a preferred vendor for oral oncology specialty medications. To order, call Northwestern at 312-926-9365.
AbbVie Endocrinology Inc. (AEI) d/b/a Pharmacy Solutions is a medical provider of Lupron Depot. To order, call Pharmacy Solutions at 888-857-0668 or fax 800-266-2065.
Prime Specialty Pharmacy is both a medical and pharmacy provider for a wide variety of specialty medications, including Synagis and hemophilia (factor) medications.
- For the current list of managed specialty medications available through Prime Specialty Pharmacy, view the Specialty Pharmacy Program Drug List.
- View the Prime Specialty Pharmacy Drug Request Form.
To contact Prime Specialty Pharmacy, call 877-627-MEDS(6337) or fax the Prime Specialty Pharmacy injectable request order form to 877-828-3939.
Prime Therapeutics Specialty Pharmacy LLC (Prime Specialty Pharmacy) is a wholly owned subsidiary of Prime Therapeutics LLC (Prime), a pharmacy benefit management company. Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association, contracts with Prime to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. HCSC, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime.