*Specialty or oncology supportive care drug (outpatient hospital only)
**Complex & rare disease drug (all outpatient places of service)
We’ll announce the specialty pharmacies that will supply these drugs prior to April 1, 2023.
Specialty pharmacy requirement
Providers are required to obtain the medications linked above from the indicated specialty pharmacies, unless otherwise authorized by us. When the specialty medication is obtained through the specialty pharmacy, the specialty pharmacy will bill us directly for these medications under the member’s medical benefit. The facility administering the specialty drug is not to bill us for the medication obtained through the specialty pharmacy.
Please contact your Network Management or Provider Relations teams.