Specialty Medical Drugs

Drug costs continue to rise, and specialty drugs contribute significantly. To counter this trend, we manage specialty drugs under the medical benefit through these Specialty Medical Benefit Management (SMBM) programs:

  • Prior Authorization: Some medical (injectable/infusible) specialty drugs will require prior authorization through the CVS/Caremark online prior authorization tool, Novologix, an industry-leading software system that assists in managing drugs reimbursed under the medical benefit. This tool is a web-based application available with single sign-on access through My Insurance ManagerSM. CVS/Caremark is an independent company that provides prior authorization services on behalf of BlueCross BlueShield of South Carolina. View the Medical Prior Authorization Drug List.
  • Self-administered Drugs: Certain self-administered drugs are only covered under the member's pharmacy benefit. Hematologists, oncologists, nephrologists and rheumatologists may continue to bill these drugs under the medical benefit. View the Self-administered Drug List.
  • Site of Care: Some infused specialty medications commonly administered in physician offices and hospitals can be safely provided at home or an infusion suite. View the Site of Care Drug List.

While these lists may change at any time, we expect to make changes quarterly.

Additional Resources