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Special Requirements and Limitations for Certain Medications

Requirements for Specialty and Complex Care Medications

Specialty and complex care medications are used to treat complex, long-term or rare medical conditions. These medications often need to be stored or given with special care. That’s why members taking these drugs need to use select specialty and complex care pharmacies.

Through these pharmacies, you can have covered self-administered specialty and complex care drugs delivered directly to you or your doctor's office. Some may even offer direct shipping at no added cost.

View the Specialty and Complex Care Drug List for a list of self-administered medications that may be covered under your pharmacy benefit.

How to order:

  • For new or to transfer existing prescriptions to Accredo, ask your doctor to call in your prescription to 1-833-721-1619 or e-prescribe your prescription to Accredo. Your doctor can find e-prescribing information at this website.
  • You may be able to use other pharmacies participating in the specialty and complex care pharmacy network. You can log in to your member account to find a pharmacy. 

*A specialty and complex care pharmacy coordinator will contact you to confirm you correct mailing address and arrange delivery of your covered medications.

Accredo® is a specialty pharmacy that is contracted to provide services to members of Blue Cross and Blue Shield of Illinois. Accredo is a trademark of Express Scripts Strategic Development, Inc.

Requirements for Generic Medication

Some brand-name drugs are also available in a generic version. If your medication is available in a generic equivalent version with the same active ingredients and at the same dosage you will pay more if you choose to buy the brand-name version. In that case, you will pay your higher copayment or coinsurance amount, plus the difference in cost between the brand drug and its generic equivalent. When you can, buying the generic version may save you money.

Learn more about generic drugs

Requirements for Over-the-Counter Medications

Keep in mind medications that can also be found over-the-counter are usually not covered through your prescription drug plan, even if your doctor has prescribed it. Because these drugs are not covered under your plan, buying the OTC version can often save you money.

Dispensing Limits for Certain Medications

To help promote safe drug usage, there are coverage rules put on certain medications. These rules affect:

  • The amount of medication covered per prescription
  • The amount of medication covered in a given time period

These limits reflect generally accepted pharmaceutical manufacturers' guidelines and help encourage medication use as intended by the U.S. Food and Drug Administration.

For more information, view the dispensing limits included in the Performance Drug List.

Please call us at 1-877-325-2996 if you have any questions.