May 28, 2020
We’re excited to introduce a pilot program for a real-time prescription benefit tool to be used by providers of Blue Cross and Blue Shield of Illinois (BCBSIL) members with the Fortune Brands employer group plan, which includes three-character member ID prefixes FBR, RML and F2N.
We appreciate your patience and support as we explore this real-time prescription benefit tool before expanding it beyond this pilot group.
The new real-time prescription benefit tool is part of the electronic medical record (EMR) system and is available during e-prescribing. The tool includes information like:
- Accurate total drug cost savings (based on actual payer costs and rebates) for up to three lower-cost, dose-matched, clinically equivalent alternative medications.
- Notice of any prior authorization requirements, as well as alternative medication(s) that may not need a prior authorization.
- Any other notifications that may cause pharmacy call-backs to the health care professional.
By reducing pharmacy call-backs to resolve drug coverage issues, this tool will help enhance provider productivity, identify possible treatment options that offer patients the lowest out-of-pocket costs and help to improve overall patient satisfaction and adherence. If lower-cost medication alternatives are shown, we encourage you to review the list of recommendations and determine if any changes in drug treatment are appropriate.
Please Note: This is a short-term pilot only for members with the Fortune Brands employer group plan, which includes three-character member ID prefixes FBR, RML and F2N. We anticipate the pilot will be extended to most BCBSIL members in the future. If your patients are not part of the Fortune Brands group, you may see error messages and real-time prescription benefit tool information may not be available. If you have questions about BCBSIL members that you feel may be missing information, and you use an Epic EMR, contact Surescripts®. For those with non-Epic EMRs, contact your EMR vendor.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment.
Pharmacy benefits and limits are subject to the terms set form in the member’s certificate of coverage. 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, limits and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.
Prime Therapeutics LLC (Prime) is a pharmacy benefit management company contracted by BCBSIL to provide pharmacy benefit management and other related services. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime.
These new tools are offered by Surescripts, an independent third-party vendor that is solely responsible for its products and services. BCBSIL makes no representations or endorsements regarding the services of Surescripts. If you have any questions or concerns about the products or services offered, you should contact the vendor directly.