Prime Therapeutics Frequently Asked Questions


The following Plan participants will have prescription coverage through Blue Cross and Blue Shield of Illinois with Prime Therapeutics as the prescription benefits manager (PBM):

  • Active agents, Employees of Agents and Employees of Trainee Agents in Group Medical Plan Options 2A and 3A.

Plan Options 2A and 3A have been designed as Health Savings Account (HSA) compatible plans. By law, in an HSA Plan, prescription drug costs must be included in the medical plan (and subject to the deductible and coinsurance), just like any other medical expense. Blue Cross and Blue Shield of Illinois and Prime Therapeutics already have existing connectivity between their systems, so Prime was an excellent choice for these plan designs.

Participants will be issued a BCBSIL Identification Card to present at a contracting network retail pharmacy. The ID card will include the appropriate information for the pharmacy to submit the claim to Prime for adjudication.

The pharmacist will be able to determine while the participant is at the counter the amount the participant owes (if the medical plan deductible and/or coinsurance on the medical plan has been met).

A drug list / formulary is a list of prescription drugs that has been approved for plan members. It is a tool designed to provide you and your physician with the most beneficial drugs at the most reasonable cost. The objective of a drug list / formulary is to promote efficient and effective health care services.

A Pharmacy and Therapeutics (P&T) committee determines what drugs are included on a drug list / formulary. The P&T committee is made up of a diverse group of doctors and pharmacists. They review scientific literature, drug reports and information on new drugs; consult with other health care professionals; and use their own expertise to make decisions about the drugs that should be included on a drug list / formulary. These decisions represent the most appropriate care for patients.

The P&T committee reviews each drug on its safety, effectiveness, uniqueness and cost when adding or removing drugs from the drug list/formulary. This ensures the drugs on the drug list / formulary are safe for patients, effective in fighting disease and affordable. The P&T committee meets quarterly to consider drug list / formulary changes. To obtain a copy of the drug list/formulary, log in to Blue Access for Members and go to My Coverage — Prescription Drugs to access the Prime Therapeutics site.

Medications that treat conditions that are not expected to last for more than 30 days are short-term medicines. Most coughs, colds, flu and infections require short-term medicines. Fill such prescriptions at a contracting retail pharmacy.

To locate contracting pharmacies, log in to Blue Access for Members and go to My Coverage — Prescription Drugs to access the Prime Therapeutics site, or call Group Medical Customer Service at 888-652-4013.

Long term or maintenance medicines are drugs that you will need to have refilled on an ongoing basis. Common maintenance medicines are those used to treat chronic conditions like high blood pressure, diabetes, asthma, depression, and ulcers. Ordering through the home delivery program with PrimeMail is a convenient way to fill prescriptions for maintenance medicines.

Mail service offers mail delivery with the highest standards of quality, safety and service for your prescription drug needs:

  • Quality — Each prescription is verified for accuracy and dispensed by a pharmacist who oversees every aspect of the process
  • Convenience — Orders are delivered to your home, work or other designated address with refill amounts and dates noted on the prescription label
  • Privacy — Orders are handled discretely and delivered in plain-labeled packaging with no indication of the contents
  • Safety — Tamper-evident closure and secure packaging protect prescriptions from breakage and temperature changes

PrimeMail offers a convenient and easy ordering process.

  • For each maintenance or long-term medication prescribed for you, ask your physician to write two prescriptions.

    One to submit to PrimeMail for up to a 90-day supply, plus 3 refills (if appropriate), and the other for immediate use to be filled at a contracting local pharmacy (up to a 30-day supply.)

  • Complete (in black ink) the Registration & Prescription Order Form which can be obtained on the BCBSIL website. You may also obtain forms by calling the Group Medical Customer Service Unit.
  • Mail to PrimeMail:
    • Your completed Registration and Prescription Order Form
    • Your original, physician-signed, maximum-day supply prescription
    • The appropriate payment

You can expect to receive your prescription within 14 calendar days after Prime receives your order.

Instructions on how to obtain a Mail Order form, and how to order refills through the Home Delivery Program will be provided during Annual Enrollment.

To obtain a Mail Order form:

  • Download the form  or
  • Call the Group Medical Customer Service Unit at 888-652-4013

You will need to obtain a new prescription from your physician and submit it to PrimeMail Home Delivery as outlined above. Any existing refills will not be automatically transferred to PrimeMail Home Delivery.

You can check the cost of your medication through the BCBSIL website by selecting the RX Drug Tab and accessing Prime Therapeutics website link. (You will need to register in order to obtain prescription costs on the Prime's website.) The cost of the medicine can vary by location and it is common for the price to fluctuate. You can also obtain medication costs by calling the Group Medical Customer Service Unit.

Quantity Limit:

There is a limit for erectile dysfunction medications of up to 8 pills every 30-days at your retail pharmacy, and up to 24 pills every 90 days at PrimeMail for VIAGRA®, Cialis®, LEVITRA® and all other medicines within the same drug category.

Due to IRS guidelines you can have a prescription drug plan either as part of your high deductible health plan or a separate plan (or rider) and qualify as an eligible individual if the plan does not provide benefits until the minimum annual deductible of the high deductible health plan (HDHP) has been met. If you can receive benefits before the deductible is met, you are not an eligible individual.

If you have questions concerning your prescription benefit, contact the Group Medical Customer Service Unit at 888-652-4013. A Customer Service Representative is available to assist you 24 hours a day, 7 days a week with prescription drug benefit questions. Agents and pharmacists are also on call after hours for urgent assistance.