Specialty Drugs

All of our plans include a specialty pharmacy benefit.

Specialty drugs are high-cost injectable, infused, oral, or inhaled medications that are typically prescribed to treat chronic or long-term conditions that have few or no alternative therapies, such as cancer, HIV/AIDS, hepatitis C, multiple sclerosis, and others. People who take specialty drugs require customized clinical monitoring and support to reduce their health risks and potentially serious side effects.

Network specialty pharmacies

Blue Cross & Blue Shield of Rhode Island (BCBSRI) has designated two pharmacies within our network to provide specialty drugs to our members who need them, at the most reasonable cost possible:

  • Walgreens Specialty Pharmacy 1-877-646-4292
  • Village Fertility Pharmacy (fertility drugs only): 1-877-334-1610

If you have any questions about our Specialty Pharmacy Benefit, please contact BCBSRI Customer Service Department at 1-800-639-2227

How the specialty pharmacy benefit works

  • All drugs listed on the Specialty Drug List must be obtained from an in–network preferred specialty pharmacy in order to receive the maximum benefit.
  • The highest network prescription drug copayment applies to specialty drugs (other than infertility drugs) that are purchased from one of our network specialty pharmacies.
  • Up to a 20% copayment may apply to specialty drugs that are used for infertility treatment.
  • Certain specialty drugs require prior authorization.
  • Specialty drugs cannot be purchased through Catamaran Home Delivery, our mail order service.
  • Specialty drugs purchased at a network retail pharmacy will have a significantly higher copayment.

The level of coverage depends on where the specialty drugs are obtained:

  • If purchased at a pharmacy: For the maximum benefit, specialty drugs should be purchased from one of the two network specialty pharmacies listed above. Specialty drugs purchased from participating network retail pharmacies have a significantly higher liability. You must obtain prior authorization from your doctor(s).
  • If administered at a physician’s office or by a home infusion provider within the Blue Cross network: When specialty drugs are administered by a physician or by a home infusion provider who participates directly with Blue Cross, they must be purchased at a participating specialty pharmacy. The physician is responsible for obtaining any prior authorizations. The provider prescribes and orders the specialty drugs at a participating specialty pharmacy, and you are responsible for paying the copayment to that pharmacy.
  • If administered at a physician’s office or by a home infusion provider outside the Blue Cross network: To get the maximum benefit when specialty drugs are administered by nonparticipating providers (including providers who participate with another Blue Cross and Blue Shield plan through the BlueCard Network), you must ensure that:
    • The specialty drug is purchased from a network specialty pharmacy, and
    • Your physician obtains prior authorization, if applicable. Find prior authorization guidelines and forms.

Otherwise, you may be responsible for up to the full cost of the medication. Please refer to your subscriber agreement to determine your eligibility for specialty drug coverage under the pharmacy benefit.

If you have any questions about specialty drug coverage, please read these FAQs or contact Customer Service at (401) 459–5000 or 1–800–639–2227 (outside of Rhode Island).