The Independence Direct Ship Drug Program is a service that allows our
network providers to order select office-based drugs eligible for coverage
under the medical benefit without paying an additional fee. Independence works
directly with our specialty drug vendors to handle processing, payment, and
delivery.
Direct ship drug request form updates
We have updated the general drug request form, which is used to
request all direct ship drugs that do not have a specific order form.
In addition, updates have been made to the following five direct ship
request forms for specific drugs, which reflect new medical policy
criteria or new formulation options:
- Hydroxyprogesterone Caproate
- Nucala? (mepolizumab)
- Stelara? (ustekinumab)
- Viscosupplementation (hyaluronate acid products) (Orthovisc?,
Synvisc?, Synvisc-One?, Euflexxa?,
Gel-One?, GelSyn-3TM, GenVisc 850?,
Hyalgan?, Hymovis?, Monovisc?, Supartz?, VISCO-3TM, Durolane?, and TriViscTM)
- Xolair? (omalizumab)
If your office has previous versions of these forms, please discard them and
use the updated forms, which are available for download on our website and can
be identified by the April 2018 date at the bottom-right corner.
New direct ship drug request forms
New forms have been created for the following drugs:
- Vivitrol? (naltrexone)
- FasenraTM (benralizumab)
These forms are available for download on our website. Please add these new
direct ship request forms to your office's form library.
For more information
For more information on the Direct Ship Drug Program, including the list of
medical benefit drugs available under this program or to download the forms, go
to our website.