Long-acting injectable medications for behavioral health conditions have been approved by the Food & Drug Administration (FDA) in recent years. They offer several benefits, including easier adherence that may lead to better overall outcomes. These medications are injections administered by a health care provider.
Injectable medications are covered by a patient's (member's) medical benefit, unlike oral medications, which are covered by the member's pharmacy benefit.
Ordering injectable medications to administer in the office may not be a common procedure for every provider in our network. However, to support our providers and patients diagnosed with behavioral health conditions, Independence Blue Cross (IBX) offers two methods that providers can use to obtain injectable behavioral health drugs:
Buy and Bill
Many providers may choose to Buy and Bill these injectable products. This means that they purchase them directly from the manufacturer, and bill IBX once the drugs are administered to our members. Providers must be familiar with how to store and handle these medications in their office prior to administration.
When choosing this method, IBX will reimburse the provider based on their fee schedule. Each drug has a specific reimbursement code listed on the fee schedule.
Due to the upfront drug cost to providers, Buy and Bill may not be suitable for every provider or patient. However, using this method in a hospital or residential setting avoids waiting for delivery and allows administration as soon as the patient and treatment team are ready.
Direct Ship Drug Program
IBX offers a Direct Ship Drug Program to our in-network providers.
Providers who do not want to incur the upfront cost of these medications but still want to offer the therapies in their office may have the drug shipped to their office. They can do this by utilizing one of our specialty pharmacy vendors — at no cost to the network provider.
Your patients (our members) would be eligible for coverage under their medical benefit when medical necessity criteria are met.
Advantages of using the Direct Ship Drug Program include:
- IBX places the order with the specialty pharmacy (based on the physician's request) and handles all payments for the drugs.
- Physicians do not have to submit reimbursement forms for the cost of the drugs.
- Physicians do not have to dedicate office space to long-term drug storage.
Behavioral health drugs currently available for Direct Ship include:
Long-acting Medications for Substance Use Disorders
- Naltrexone (Vivitrol)
- Buprenorphine (Sublocade, Brixadi)
Long-acting Antipsychotics (LAIs)
- Aripiprazole LAI (Abilify, Maintenna, Asimtufii)
- Aripiprazole lauroxil (Aristada)
- Esketamine (Spravato)
- Paliperidone four-week (Invega, Sustenna)
- Paliperidone 12-week (Invega, Trinza)
- Paliperidone six-month (Invega, Hafyera)
- Risperidone microsphere for IM (Risperdal, Consta, Rykindo)
- Risperidone SQ (Uzedy, Perseris)
Once providers are ready to place an order, they can download the appropriate drug request form and fax to IBX (along with a valid prescription) to the number listed on the form.
If the needed drug does not have a corresponding form, please use the general request form. This drug form also serves as the prior authorization.
Finding the option that works best for both providers and patients can help alleviate obstacles and challenges. While these drugs are a vital part of treatment for many patients with behavioral health conditions, they can be expensive, complex, and difficult to access in some settings.
For more information on the Direct Ship Drug Program and the drugs covered under this program, contact Provider Customer Service at 1-800-ASK-BLUE (1-800-275-2583).