Blue Cross of California & PrecisionRx Specialty Solutions

Blue Cross of California has announced changes to its members’ prescription drug benefit that requires beneficiaries to obtain specialty medications from its network specialty pharmacy, PrecisionRx Specialty Solutions. In its letter to providers, Blue Cross of California states that Effective April 1, 2008, members taking oral and adjunct oncology, transplant, and a small number of other specialty medications will also need to obtain these from our network specialty pharmacy.

ANCO, CMA, and Blue Cross teleconferenced on March 31st to discuss the impact of this change on medical oncology practices. ANCO, CMA, and Blue Cross agreed that:

1. The changes only impact Blue Cross beneficiaries with a pharmacy benefit provided by Blue Cross.

2. Only oral and other drugs requiring a prescription must be filled via PrecisionRx.

3. If a physician buys and bills Blue Cross for an injectable drug administered in the physician office setting, then they may purchase that drug from their regular supplier of choice and bill Blue Cross under the beneficiary’s medical benefit. In other words, there will be no change in how medical oncologists buy and bill for injectable drugs administered in the physician office setting.

Please let ANCO know if you encounter any difficulties with Blue Cross vis-à-vis billing for your non-prescription injectable drugs administered in the physician-office setting.