Administered Specialty Pharmacy
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508C Provider-Administered Specialty Pharmacy Products
www.bcbst.comProvider-Administered Specialty Pharmacy Products The provider -administered specialty drugs listed below require proi r authorziation. Provdei rs may request a prior authorization review by one of the following methods: • ®Log in to . Availity . Select the Tennessee region, and then select “Payer Space.” Click the
Provider Administered Specialty Drugs - Florida Blue
www.bcbsfl.comProvider Administered Specialty Drugs* Current 1/1/22 . LDD: Limited Distribution Drug (Dispensing pharmacy can be found here: Limited Distribution Drugs ); PA: Prior Authorization; QL: Quantity Limit . 1. These drugs are covered as Self -Administered or Provider -Administered Specialty Pharmacy drugs . 2.
Self-Administered Specialty Drugs - Florida Blue
www.bcbsfl.comCovered as Self-Administered or Provider -Administered Specialty Pharmacy drug s. 2. CVS/ Caremark is our preferred in- network pharmacy for hemophilia products. * Important information on page 1 Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association .
508C, Specialty Pharmacy Network
www.bcbst.comSpecialty Pharmacy Network The pharmacies in our Specialty Pharmacy Network provide our members with self-administered and provider-administered specialty drugs at discounted rates. When your doctor sends your prescription to the specialty pharmacy, they’ll send your drugs to your home or provider’s office. Pharmacy
Bayer Women’s HealthCare Support Specialty Pharmacy ...
www.gramercygynecology.comThe Specialty Pharmacy Program prescription process To order Kyleena, Mirena or Skyla, complete the Specialty Pharmacy Prescription Request Form as follows: ... Mirena or Skyla will be administered • Indicate appropriate diagnosis code • Sign the prescription • For ARNP, NP, and PA, identify who your collaborative agreement is with if ...
OGB Pharmacy Benefits Program Full Formulary …
mp.medimpact.comOGB Pharmacy Benefits Program Full Formulary Administered by MedImpact April 2020 Foreword A formulary is a list of both generic and brand-name prescription drugs that are preferred by a prescription drug program. The purpose of the MedImpact formulary is to provide your doctors and pharmacists with a method to ... Specialty (Tiers 4 /5/6 ) 50% ...
Prime Therapeutics LLC
www.myprime.comSpecialty Pharmacy Drug Management List Neither this Specialty Pharmacy Drug Management List, nor the successful adjudication of a pharmacy claim, is guarantee of payment. Prime Therapeutics LLC is an independent company providing pharmacy benefit management and specialty pharmacy services for eligible Blue Cross and Blue Shield members.
Specialty pharmacy requirements - UHCprovider.com
www.uhcprovider.comThe requirement to use a specialty pharmacy applies to additional drugs administered in an outpatient hospital setting. To meet the requirements, outpatient hospital providers must order the medications listed in the chart from the indicated specialty pharmacies, unless otherwise authorized by UnitedHealthcare. •
Specialty Drug Program - BCBSM
www.bcbsm.comSelf-administered drugs** Our specialty pharmacy mail order vendor is AllianceRx Walgreens Prime, 1-866-515-1355. Coverage for these drugs will vary based on your pharmacy benefits. See your plan’s drug list for specific coverage details. Antineoplastics (cancer drugs) Actimmune ® (chemotherapy)continued Afinitor ® (pa)
Specialty Medication Precertification Request
www.aetna.comSpecialty (Check one): Oncologist. Hematologist. Other: D. DISPENSING PROVIDER/ADMINISTRATION INFORMATION Place of Administration: Self-administered . Physician’s Office . Outpatient Infusion Center . Phone: Center Name: Home Infusion Center . Phone: Agency Name: Administration code(s) (CPT): Address: Dispensing Provider/Pharmacy: Patient ...
Specialty Pharmacy Drug List - Magellan Rx Management
magellanrx.comSpecialty medications may be covered under either the medical or pharmacy benefit. Please consult your insurance documentation to determine which benefit covers these medications. We offer a broad specialty medication list containing nearly 500 drugs, covering 42 therapeutic categories and specialty disease states.
Specialty Medication Precertification Request
www.aetna.comSpecialty (Check one): Oncologist. Hematologist. Other: D. DISPENSING PROVIDER/ADMINISTRATION INFORMATION Place of Administration: Self-administered . Physician’s Office . Outpatient Infusion Center . Phone: Center Name: Home Infusion Center . Phone: Agency Name: Administration code(s) (CPT): Address: Dispensing …
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