New Pharmacy Benefit Manager in 2005

Health Care Service Corporation (HCSC), which operates Blue Cross and Blue Shield of Illinois (BCBSIL), has joined several other Blue Cross licensees in acquiring an ownership interest in Prime Therapeutics, a national pharmacy benefit manager (PBM).

Pending regulatory approval, on January 1, 2005, Prime Therapeutics will assume the management of pharmacy benefits for all BCBSIL health care benefit plans, including prescription drug coverage and home delivery.

As our new PBM, Prime Therapeutics will process prescription drug claims submitted electronically by pharmacies and will provide other services, such as customer inquiries, formulary management, clinical programs and national pharmacy network contracting.

Ongoing Communications
We will work closely with Prime and our existing PBM (AdvancePCS) during the coming year to create a smooth transition for your clients. We will provide you with updates along the way, and inform members and employer groups about the changeover as the effective date draws closer. Members will receive new ID cards and informational materials about the change.

Anticipated Benefits
Prime Therapeutics combines the economies of scale of a national PBM with the customization, flexibility and service provided by an in-house solution, rather than an outside vendor. With the changeover to Prime, we gain the ability to further integrate our pharmacy and health care benefit management and achieve closer coordination with our disease care management programs.

“By investing in the ownership of a Blues approach to prescription drug benefit management, we expect to have greater control over pharmacy costs and how we manage the pharmacy benefit for our customers,” said Raymond F. McCaskey, HCSC president and CEO.

Continued Customer Service
If your clients currently offer prescription drug benefits through BCBSIL, their coverage will not be affected by this PBM change. Prime will provide the same services your client groups already receive, including:

• claims processing
• formulary management
• clinical programs
• home delivery
• utilization management and reporting
• national network management

HMO plans and insured plans for groups with 2-150 employees include pharmacy benefits through BCBSIL. If your client’s drug benefits are provided by a different PBM, this is an excellent opportunity for them to simplify their health care and pharmacy benefits through one source – BCBSIL.

Your General Agent or Blue Cross representative can answer any questions about this change.

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