Medicaid

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). 

Drug Lists

Drug List - Blue Cross Community Health Plans

Drug List - Blue Cross Community MMAI (Medicare-Medicaid Plan)SM

Pharmacy Directory

Pharmacy Directory - BCCHP

Pharmacy Directory - MMAI

Mail Service New Prescription Fax Order Form (MMAI) 

Mail Service for BCCHP or MMAI: ePrescribe new prescriptions to EXPRESS SCRIPTS HOME DELIVERY or call 888-327-9791 for faxing instructions

Specialty Pharmacy Fax Order Form (MMAI) 

Specialty Pharmacy Fax Order Form (BCCHP or MMAI)

BCCHP Forms on MyPrime

MMAI Forms on MyPrime

Prior Authorization

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: 

For BCCHP plans, fax 877-480-8130, call 1-866-202-3474 (TTY/TDD 711) or submit electronically on MyPrime or CoverMyMeds login page.

For MMAI plans, fax 800-693-6703, call 1-877-723-7702 (TTY/TDD 711) or submit electronically on MyPrime  or CoverMyMeds login page

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.