Blue Cross and Blue Shield of Illinois

 

October 18, 2013

Reminder: Members to Be Notified of Upcoming Self-Administered Specialty Drug Claims Processing System Edit

As a reminder, beginning Jan. 1, 2014, Blue Cross and Blue Shield of Illinois (BCBSIL) will expand its claims processing system edit to redirect professional claims for fertility, oral oncology and various other select self-administered specialty drugs.* Impacted members will be advised through letters sent in late October. Providers may also be alerted by letters, which were mailed earlier this month.

The letters sent to impacted members will advise them on how to obtain their self-administered specialty medication, as well as include a sample list of the specialty medications included in this claims processing system edit expansion.

A list of specialty drugs is available on the bcbsil.com member and provider websites. On the list, medications that require administration by a health care professional, and are often covered under a member’s medical benefit, are identified with an “(M)” on the member version (and listed as such on the provider version). Other medications on the list are approved by the U.S. Food and Drug Administration (FDA) for self-administration, and are usually covered under the member’s prescription drug benefit. In this case, the member’s doctor must write or call in the prescription to a pharmacy provider contracted to provide specialty services.

If you have further questions about this change, please contact your BCBSIL representative.

*The various other select specialty drugs of this system edit expansion will include: Actimmune, Apokyn, Firazyr, Fuzeon, Leuprolide Acetate, Octreotide Acetate and Stelera.

Third-party brand names are the property of their respective owners.

 


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A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.