Prescription drugs are covered in two ways — through the Healthy Blue pharmacy benefit or medical benefit. The method of coverage depends on whether the drug is self-administered or administered by a health care professional in a clinical setting like a doctor’s office.
Drugs that are only administered to members by healthcare professionals are available under the medical benefit and can be obtained in several ways:
- Buy and bill: Physicians may purchase drugs directly through pharmaceutical wholesalers and distributors and submit a claim to Healthy Blue. To review the list of services and drugs that are billable on the medical benefit for Healthy Blue, please refer to the State Fee Schedule.
- Delivery: Physicians may request delivery of a member specific specialty medication that will be administered in their office, by calling Healthy Blue’s contracted medical specialty pharmacy (MSP), CVS Specialty®.
- Referral: Physicians may refer their members to infusion suites and outpatient hospital services.
Prior authorizations will be handled by Novologix.
Novologix will handle prior authorization for drugs covered under the medical benefit.
Novologix® is an independent company providing prior authorization and pharmacy services on behalf of BlueChoice HealthPlan.