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Pharmacy Benefits Notification

Posted May 31, 2018
Blue Cross and Blue Shield of Illinois (BCBSIL) uses Prime Therapeutics LLC as our pharmacy benefit manager to administer our pharmacy program to help contain rising drug costs and maintain and improve the quality of care delivered to members.

For certain drugs, prior approval and quantity limits are in place to help ensure the current medically appropriate drug guidelines are followed.

For more information regarding our pharmacy programs, refer to the Pharmacy Benefit Tips, Guidelines and Reminders article in the January 2018 issue of the Blue Review or visit the pharmacy section located on our Provider website. For Federal Employee Program (FEP) pharmacy information, visit fepblue.org/pharmacy. We encourage you to check for updates regularly. The following information is available on the above referenced links:

  • Copies of our drug lists, including restrictions and preferences
  • How to use our pharmacy procedures
  • An explanation of limits or quotas
  • How you can provide information to support an exception request
  • The process for generic drug substitutions, therapeutic interchange and step-therapy protocols

Prime Therapeutics LLC is a pharmacy benefit management company. BCBSIL contracts with Prime to provide pharmacy benefit management and related other services. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime.

The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Physicians are to exercise their own medical judgment. Pharmacy benefits and limits are subject to the terms set forth in the member’s certificate of coverage which may vary from the limits set forth above. The listing of any particular drug or classification of drugs is not a guarantee of benefits. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.