Direct Ship Injectables Program

Overview

The Independence Blue Cross (IBX) Direct Ship Injectables Program facilitates the shipment and precertification (as required) of injectable medications such as Synvisc^®, Hyalgan^®, Lupron^®, Zoladex^®, and other injectable drugs that are not commonly stocked in a physician’s office.

Note: Items that are not available through this program include most vaccines, antibiotics, chemotherapy, vitamin B-12 injections, and drugs administered by infusion or routinely obtained by the physician at a relatively low cost.

This voluntary program is available to you or all of your patients who have their medical benefits through an IBX managed care program.

Program Details

Please refer to the following information about the Direct Ship Injectables Program:

• Drug requests. Complete and fax the appropriate request form (see below) to 215–761–9165 along with a valid prescription. You may also submit the request electronically using the NaviNet^® web portal. Certain medications require prior authorization. For these medications, the request form will also serve as your prior authorization request.
• Shipment. Medications are shipped to the specified address two to five business days after the IBX Pharmacy Services department receives the completed request.
• Billing. The injectable distributor bills IBX directly, eliminating the need for you to bill for reimbursement of the drug.
• Refills. Ordered refills are automatically shipped out at the appropriate time. You will not need to complete any additional paperwork.
• Quantity limits. For agents such as Synvisc^® and Hyalgan^®, quantities are limited to the amount required for one complete course of therapy. Quantities for all other injectables will be evaluated to promote appropriate prescribing.
• Benefits coverage. Drugs obtained through the program are subject to the member’s contract exclusions and medical necessity review.
• Preferred brands. Certain injectable drugs have been identified as preferred brands based on their cost–effectiveness to the plan and are highlighted in bold below. Choosing one of these preferred brands does not affect the member’s cost–sharing for the drug.

Forms

Please note that the forms below are only for drugs covered under the medical benefit. Injectable drugs listed in bold indicate preferred brands. Choosing one of these preferred brands does not affect the member’s cost–sharing for the drug.

Direct Ship Injectables Request Form (general form for agents not listed below)

Botulinum toxins (Botox^®, Dysport^®, Myobloc^®)

Makena^™ (17 alpha-hydroxyprogesterone caproate)

Prolia^®/Xgeva^®

Psoriasis agents (Stelara^®)

Synagis^® (palivizumab)

Viscosupplementation (hyaluronate acid products) (Orthovisc^®, Synvisc^®, Synvisc–One^®, Euflexxa^®, Gel-One ^®, Supartz^®, and Hyalgan^® )

Xolair^® (omalizumab)

For more information, please contact us.

Website last updated: 12/31/2014
Y0041_HM_15_20730c Approved 1/14/2015