CurrentFlorida BluePolicy N/A

Provider Administered Specialty Drugs

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This document lists provider-administered specialty drugs subject to medical benefit coverage, notes prior authorization (PA), limited distribution drug (LDD) status, and other program details for providers and members of Florida Blue.

Policy Summary

PayerFlorida Blue

PolicyProvider Administered Specialty Drugs

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionRefer to the Prior Authorization Program Information and Forms and member contract benefits to determine whether Prior Authorization is required.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

hundredsspecialty drugs listed (approx.)

LDD, PA, QLdrug attributes indicated

PADPbuy-and-bill program

Contact Centerprovider phone support

Coverage Determinations for Listed Drugs

Covered with criteria

Covered when the following conditions are met:

Drugs listed are covered under the medical benefit unless a member contract or plan excludes them; medical coverage benefits apply.

Many entries in the list are annotated with one or more of the following attributes to indicate program requirements: PA (Prior Authorization), LDD (Limited Distribution Drug), QL (Quantity Limit).

Prior Authorization requirements may vary by drug and by member plan; refer to member contract benefits and the Prior Authorization Program Information and Forms to determine PA applicability.

Certain specialty drugs may be Limited Distribution Drugs (LDD) and are only available from a specific specialty pharmacy; the appropriate dispensing pharmacy can be found at the Limited Distribution Drugs resource.

If a provider is enrolled in the Provider Administered Drug Program (PADP) and intends to buy-and-bill a drug on this list, consult the PADP section of the online provider manual for the current list of included drugs.

This is not an all-inclusive list of medical-benefit drugs or of drugs that may require Prior Authorization; certain drugs on the list may not be covered by specific plans.

Drug Attribute Flags and Coding

Drug attribute flagsmixed

PA	Prior Authorization required
LDD	Limited Distribution Drug (specific dispensing pharmacy)
QL	Quantity Limit

Drug attribute flags (alternate presentation)mixed

PA	Prior Authorization required
LDD	Limited Distribution Drug (specific dispensing pharmacy)
QL	Quantity Limit

Provider Requirements and Program Guidance

Prior Authorization

Prior Authorization (PA) requirement and contact

Prior Authorization (PA) may be required for certain drugs; providers should refer to the Prior Authorization Program Information and Forms and member contract benefits to determine PA requirements and coverage. For assistance after consulting those resources, contact Customer Service (phone on member insurance card) or the Provider Contact Center at 1-800-727-2227 (health care providers and office staff only).

Billing Rule

PADP buy-and-bill guidance

If you are enrolled in the Provider Administered Drug Program (PADP) and wish to buy-and-bill a drug on this list, refer to the PADP section of the online provider manual for the current list of included drugs.

Documentation Required

Limited Distribution Drugs (LDD) guidance

Certain specialty drugs are Limited Distribution Drugs (LDD) and may only be available from a specific specialty pharmacy or location; the appropriate dispensing pharmacy can be found at the Limited Distribution Drugs resource.

Key Terms and Coverage Modality

Acronyms used in list

LDDLimited Distribution Drug — certain specialty drugs available only from a specific specialty pharmacy or location; the appropriate dispensing pharmacy can be found at the Limited Distribution Drugs resource.

PAPrior Authorization — prior authorization may be required for certain drugs; refer to the Prior Authorization Program Information and Forms and member contract benefits to determine PA requirements.

QLQuantity Limit — prescribing or dispensing quantities may be limited per policy or plan specifications.

Coverage modality

Coverage modalityDrugs listed are covered as Self-Administered or Provider-Administered Specialty Pharmacy drugs; medical coverage benefits apply and plan-level exclusions may exist.

Buy-and-bill (PADP)If enrolled in the Provider Administered Drug Program (PADP) and wishing to buy-and-bill a drug on this list, providers should refer to the PADP section of the online provider manual for included drugs.

Coordination optionMay coordinate with Florida Cancer Specialists if a provider is unwilling to buy/bill.

Policy Summary

PayerFlorida Blue

PolicyProvider Administered Specialty Drugs

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionRefer to the Prior Authorization Program Information and Forms and member contract benefits to determine whether Prior Authorization is required.

SourceLink

On This Page

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CurrentFlorida BluePolicy N/A

Provider Administered Specialty Drugs

Customize your policy alerts

Sign up for all Florida Blue policy alerts

Know when Florida Blue releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerFlorida Blue

PolicyProvider Administered Specialty Drugs

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionRefer to the Prior Authorization Program Information and Forms and member contract benefits to determine whether Prior Authorization is required.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

hundredsspecialty drugs listed (approx.)

LDD, PA, QLdrug attributes indicated

PADPbuy-and-bill program

Contact Centerprovider phone support

Coverage Determinations for Listed Drugs

Covered with criteria

Covered when the following conditions are met:

Drugs listed are covered under the medical benefit unless a member contract or plan excludes them; medical coverage benefits apply.

Many entries in the list are annotated with one or more of the following attributes to indicate program requirements: PA (Prior Authorization), LDD (Limited Distribution Drug), QL (Quantity Limit).

Prior Authorization requirements may vary by drug and by member plan; refer to member contract benefits and the Prior Authorization Program Information and Forms to determine PA applicability.

This is not an all-inclusive list of medical-benefit drugs or of drugs that may require Prior Authorization; certain drugs on the list may not be covered by specific plans.

Drug Attribute Flags and Coding

Drug attribute flagsmixed

PA	Prior Authorization required
LDD	Limited Distribution Drug (specific dispensing pharmacy)
QL	Quantity Limit

Drug attribute flags (alternate presentation)mixed

PA	Prior Authorization required
LDD	Limited Distribution Drug (specific dispensing pharmacy)
QL	Quantity Limit

Provider Requirements and Program Guidance

Prior Authorization

Prior Authorization (PA) requirement and contact

Billing Rule

PADP buy-and-bill guidance

Documentation Required

Limited Distribution Drugs (LDD) guidance

Key Terms and Coverage Modality

Acronyms used in list

QLQuantity Limit — prescribing or dispensing quantities may be limited per policy or plan specifications.

Coverage modality

Coverage modalityDrugs listed are covered as Self-Administered or Provider-Administered Specialty Pharmacy drugs; medical coverage benefits apply and plan-level exclusions may exist.

Coordination optionMay coordinate with Florida Cancer Specialists if a provider is unwilling to buy/bill.

Policy Summary

PayerFlorida Blue

PolicyProvider Administered Specialty Drugs

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionRefer to the Prior Authorization Program Information and Forms and member contract benefits to determine whether Prior Authorization is required.

SourceLink

On This Page