This information applies to Medicaid members who have Blue Cross Community Health PlansSM (BCCHP) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM prescription drug benefits. Prime Therapeutics is the Pharmacy Benefit Manager (PBM) that provides drug benefits through Blue Cross and Blue Shield of Illinois (BCBSIL).
Providers can access, complete, and submit prior authorization and step therapy request forms electronically from the CoverMyMeds login page.
Prescription Exception Requests
Providers may submit coverage exception requests by fax, phone or electronically:
Managed Care Organization (MCO) Pharmacist Clinical Reviews
Health care professionals should know that BCBSIL's MCO pharmacists will use the Illinois Prescription Drug Monitoring Program to carry out clinical reviews for our BCCHP or MMAI members. These reviews will help make sure opioid prescription drug use is in compliance with the Illinois Controlled Substances Act, or House Bill 4650, and the section covering “medication and pharmacy shopping”.
The drug list and pharmacy network may change at any time.
Blue Cross Community Health Plans and Blue Cross Community MMAI plans are provided by Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association.