Specialty Drug Management Changes for Anthem Blue Cross Health Plans

A better way to manage specialty drugs

September 26, 2016

Health care costs continue to rise, and specialty drugs are a big contributor. These prescription medicines are used to treat complicated and chronic conditions, such as hepatitis C, cancer and multiple sclerosis. As specialty drugs become more widely used, we’re looking for new ways to control costs while keeping members healthy. That’s why we created our Right Drug Right Channel (RDRC) program.

We will now offer two Right Drug Right Channel programs beginning January 1, 2017:

1. Right Drug Right Channel Medical to Pharmacy: Certain self-administered drugs that were covered under the medical benefit will now be covered under the pharmacy benefit.
2. NEW! Right Drug Right Channel Pharmacy to Medical: Certain specialty drugs that were covered under the pharmacy benefit will now be covered under the medical benefit. This is a new program that will be offered in addition to the Right Drug Right Channel Medical to Pharmacy program.

Our Right Drug Right Channel programs ensure:

• Better medication management: Members are reminded about refills and have access to support programs through the specialty pharmacy provider.
• Better cost management: By placing drugs under the appropriate benefit.
• Simplify access to medications: RDRC simplifies which benefit the drug falls under based on how the medication is administered.

In the coming weeks, we’re reaching out to group members affected by this change. If they don’t have pharmacy coverage with us through their employer, they will need to contact their pharmacy provider for coverage information for drugs moving from medical to pharmacy.

If a member believes this change poses a hardship, he or she and/or the member’s doctor can ask us to keep covering the drug(s) under the member’s pharmacy benefit by submitting a request for an exception by calling us at the number on the member’s ID card.

This article applies to:

California Small Group, Large Group, and Individual (under 65)

Right Drug Right Channel Specialty Drug Program

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Specialty drugs not covered by the pharmacy benefit

Specialty drugs not covered by the medical benefit