Specialty Pharmaceutical Drugs Sample Clauses

Specialty Pharmaceutical Drugs. The mail order pharmacy for specialty drugs is AllianceRx Walgreens Prime, an independent company. Specialty prescription drugs (such as Enbrel® and Humira®) are used to treat complex conditions such as rheumatoid arthritis, multiple sclerosis and cancer. These drugs require special handling, administration or monitoring. AllianceRx Walgreens Prime will handle mail order prescriptions only for specialty drugs while many in-network retail pharmacies will continue to dispense specialty drugs (check with your local pharmacy for availability). Other mail order prescription medications can continue to be sent to Express Scripts. (Express Scripts is an independent company providing pharmacy benefit services for Blues members.) A list of specialty drugs is available on our Web site at xxxxx.xxx/xxxxxxxx. If you have any questions, please call AllianceRx Walgreens Prime customer service at 0-000-000-0000. We will not pay for more than a 30-day supply of a covered prescription drug that BCBSM defines as a "specialty pharmaceutical" whether or not the drug is obtained from a 90-Day Retail Network provider or mail-order provider. We may make exceptions if a member requires more than a 30-day supply. BCBSM reserves the right to limit the quantity of select specialty drugs to no more than a 15-day supply for each fill. Your copay/coinsurance will be reduced by one-half for each fill once applicable deductibles have been met. Select Controlled Substance Drugs - BCBSM will limit the initial fill of select controlled substances to a 5-day supply. Additional fills for these medications will be limited to no more than a 30-day supply. The controlled substances affected by this prescription drug requirement are available online at xxxxx.xxx/xxxxxxxx. Member's responsibility (copays and coinsurance amounts) Note: Your prescription drug copays and coinsurance amounts, including mail order copay and coinsurance amounts, are subject to the same annual out-of-pocket maximum required under your medical coverage. The following prescription drug expenses will not apply to your annual out-of-pocket maximum. • any difference between the Maximum Allowable Cost and BCBSM's approved amount for a covered brand-name drug • the 25% member liability for covered drugs obtained from an out-of-network pharmacy Benefits 90-day retail network pharmacy * In-network mail order provider In-network pharmacy (not part of the 90-day retail network) Out-of-network pharmacy Tier 1 - Generic or select pre...
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