Thursday, June 7, 2012

BCBSNC Announces Prime Network Changes in July

Blue Cross Blue Shield of North Carolina (BCBSNC) made the transition to Prime Therapeutics (Prime) as its new pharmacy benefits manager effective April 1, 2012.  At that time, all pharmacies were allowed (if they were willing and the doctor wrote the prescription that way), to dispense up to a 90 day supply of medication. Typically, pharmacies have to sign an additional contract with Prime in order to be able to dispense greater than a one month supply. In order to ease the transition for our members to Prime, BCBSNC asked Prime to waive this requirement, and allow members to continue to get a two or three month supply of medication at a pharmacy as long as they had a basic contract.

As of July 1, BCBSNC will have Prime enforce their contract requirements. What this means is that if a pharmacy does not have a contract with Prime to dispense greater than a one month supply, then the pharmacy will only be able to dispense a one month supply.

Key Points
  • Members whose pharmacy has not yet signed a contract with Prime to provide extended supplies of medications may need to visit a different pharmacy to receive an extended supply of their medication.
  • Member Mailing Began Last Week: Members who have received an extended supply of a medication within the last six months are being mailed the letter below starting May 25 to inform them of this change.
  • BCBSNC specialty pharmacies will continue to be able to dispense up to a 90 day supply through 12/31/12.  Please note that in late March, BCBSNC notified sales staff and agents that beginning July 1, 2012, specialty medications would only be dispensed in quantities equivalent to a 30 day supply to most members with BCBSNC pharmacy benefits. BCBSNC has amended the effective date of this change, so that all BCBSNC customers with BCBSNC pharmacy benefits will be able to receive up to a 90-day supply of specialty drugs through December 31, 2012.

Please see the FAQs and sample member letter for more information.

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