Updated Specialty Pharmacy Network for HMO Illinois® and Blue Advantage HMOSM Members
Posted March 25, 2016
Effective April 1, 2016, Prime Therapeutics (“Prime”) is updating its independently contracted specialty pharmacy network. This change will impact all HMO Illinois and Blue Advantage HMO members with prescription drug benefits administered through Prime when those members seek to fill their specialty medication prescriptions.
All specialty medication prescriptions filled by Prime must be filled at one of the contracted pharmacies within the updated specialty pharmacy network in order to receive pharmacy benefit coverage consideration. If a pharmacy outside of the updated specialty pharmacy network is used, the member will be responsible for up to the full cost of their specialty medication.
This updated specialty pharmacy network consists of independently contracted pharmacies within Prime’s current retail pharmacy network that meet updated terms and conditions, such as being accredited specialty pharmacies that offer 24/7/365 access to a clinician for assistance with care coordination, condition management and other support services.
Letters were sent in March 2016 to HMO members with recent specialty drug fills at pharmacies outside of this updated specialty pharmacy network to provide notification of this change and a list of alternative pharmacies. To help minimize potential disruptions in service, BCBSIL is assisting members with transitioning their current prescriptions to in-network pharmacies.
The specialty pharmacy network list is available on Prime’s member website at MyPrime.com and also may be accessed on our secure member website, Blue Access for MembersSM. Providers may view the list in the Specialty Pharmacy section of our Provider website.
Please note that the above referenced change does not apply to Blue Precision HMOSM or BlueCare DirectSM HMO members.
Prime Therapeutics LLC is a pharmacy benefit management company. BCBSIL contracts with Prime to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. BCBSIL, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime.
The information in this article is not a guarantee of benefits. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms and conditions under the member’s certificate of coverage including benefits, limitations and exclusions in effect on the date of the service.