Behavioral Health Specialty Medications
Behavioral Health specialty medications are plan risk as well as the UM review. Prescribed medications, if medically necessary, will be dispensed by a Blue Shield contracted Specialty Pharmacy. The Behavioral Health Specialty Medications list will be updated by Blue Shield Pharmacy Services when there are changes to the list. View a listing of the Behavioral Health specialty medications below:
The CAR-T Agents list will be updated by Blue Shield Pharmacy Services when there are changes to the list. Available CAR-T Agents administered in either an inpatient setting or outpatient setting (non-office) can be found on the listing below:
CAR-T Agents that are approved for administration in an office are also identified on the Richman Injectables List below.
Section 1375.8 of the California Health and Safety Code (commonly referred to as the Richman Bill) prohibits Blue Shield from requiring Group to assume financial responsibility for the following injectable drugs when administered in the office of a physician and surgeon to a member enrolled in a commercial benefit program, or prescribed by a physician and surgeon for self-administration by a member enrolled in a commercial benefit program:
- Injectable chemotherapeutic medications and injectable adjunct pharmaceutical therapies for side effects
- Injectable medications or blood products used for hemophilia
- Injectable medications related to transplant services
- Adult vaccines
- Self-injectable medications
- Other injectable medication or medication in an implantable dosage form costing more than two hundred and fifty dollars ($250) per dose.
Most drugs in this listing are accessed through a physician provider office, infusion provider or delivery to physician office by specialty pharmacy provider; dependent on the contract between Blue Shield and the IPA/medical group.
Many drugs covered under the medical benefit require prior authorization based on the Blue Shield Drug Policies approved by the Blue Shield Pharmacy & Therapeutics Committee. Prior authorization is delegated to the IPA/medical group.
Members must obtain their hemophilia factor through our exclusive hemophilia network pharmacy CVS Caremark® unless the employer group has opted out of our preferred hemophilia network.
View current and past listings of Richman Injectables below: