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Specialty Pharmacy

Prime Specialty Pharmacy is the specialty pharmacy program offered by Prime Therapeutics.  For specialty pharmacy program information, call 1.877.627.MEDS (6337).

Specialty medications are generally prescribed for people with complex or ongoing medical conditions such as multiple sclerosis, hemophilia, hepatitis C and rheumatoid arthritis. These high cost medications also have one or more of the following characteristics:

  • Injected or infused, but some may be taken by mouth
  • Unique storage or shipment requirements
  • Additional education and support required from a health care professional
  • Usually not stocked at retail pharmacies

  Specialty Drug List

For a complete list of Prescription/Pharmacy Intake Forms, go to our Forms page and select "Provider Forms".  The forms are listed in alphabetical order under Prime Specialty Pharmacy Referral Forms. You may also click on link below.

Download Prime Specialty Pharmacy Referral Forms

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For medications that are FDA approved for self-administration, BCBSMT members with Prime Therapeutics, LLC, as their drug vendor, are required to use their pharmacy benefit and acquire self-administered drugs (oral, topical and injectable) through Prime Specialty Pharmacy.  Self-administered drugs must be billed under the member's pharmacy benefit for members to receive coverage. 

If services are submitted on professional/ancillary electronic or paper (CMS-1500) claims for drugs that are FDA approved for self-administration and covered under the prescription drug benefit, BCBSMT will notify the provider that these claims need to be re-filed through the member's pharmacy benefit.  In this situation, the following message will be returned on the electronic payment summary or provider claim summary:  "Self-administered drugs submitted by a medical professional provider are not within the member's medical benefits.  These charges must be billed and submitted by a pharmacy provider."

To help you determine the correct path for medication fulfillment and ensure that the correct benefit is applied, please refer to the specialty drug list above.  The list identifies those drugs that are approved for self-administration and therefore covered under the pharmacy benefit.

For Factor medications used to treat hemophilia, members can also contact Accredo Health Group Inc, (Accredo®) at 866-712-5007 to obtain these specialty medications.  The relationship between BCBSMT and Accredo Health Group Inc is that of independent contractors.

 
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