Designated Specialty Pharmacies in 2021

Empire BlueCross BlueShield (Empire) is developing a designated group of pharmacies to provide specialty medications in support of our insured members’ benefits in 2021. The designated specialty pharmacies will supply only specialty drugs covered under the member benefit plan. This process will have no impact on how members obtain non-specialty pharmacy drugs at retail pharmacies or by mail-order. Our designated specialty pharmacy providers will fulfill and distribute specialty pharmaceuticals more efficiently by alleviating the “buy and bill” process that sometimes applies to specialty medications provided in the outpatient facility setting.

 

To comply with member benefit terms, hospitals will be required to obtain select specialty pharmacy medications to be administered in the outpatient setting through CVS Specialty for all service dates on and after January 1, 2021. Failure to obtain medications through the designated specialty pharmacy network may result in claim denials.

 

The specialty pharmacy drugs required to be obtained from a designated specialty pharmacy will be posted at www.empireblue.com for reference and is subject to change.  Any authorizations and UM support will continue to be managed through the member’s medical carrier.

 

If your hospital is interested in becoming a designated specialty pharmacy, please contact your Empire provider contracting team for more details. 

 

730-1020-PN-NY