Provider-Administered Specialty Pharmacy Product Review Policy
DESCRIPTION
The purpose of this document is to establish a policy for the completion of a New Drug Therapy Review prior to the coverage of new to market provider-administered specialty pharmacy products. Following approval of a provider-administered specialty pharmacy product by the Food and Drug Administration, the Pharmacy and Therapeutics (P&T) Committees engage in a New Drug Therapy Review. This Review evaluates the product’s effectiveness, safety, and affordability and determines coverage parameters and a utilization management strategy.
Specialty pharmacy products are those products that require in-depth patient teaching, coordination of care, and frequent monitoring to ensure successful use. They are described by at least one of the following:
produced through genetic technology or biopharmaceutical processes;
target a chronic, rare, genetic, or complex disease; or
require unique handling, distribution, and/or administration.
POLICY
All new to market provider-administered specialty pharmacy products will be excluded from coverage until the P&T committees complete the New Drug Therapy Review. Once the New Drug Therapy Review is complete, provider-administered specialty pharmacy products may move to a covered status. A provider-administered specialty pharmacy product is not covered unless and until it is included on BCBST’s online list of provider-administered specialty pharmacy products, which as of the effective date of this policy is available at https://www.bcbst.com/docs/pharmacy/provider-administered-specialty-pharmacy-list.pdf.
ORIGINAL EFFECTIVE DATE: 12/31/2019
MOST RECENT REVIEW DATE: 12/31/2019
ID_Pharmacy
This document has been classified as public information.