Pharmacy Programs

These pharmacy programs are available for members.

Prior Authorization/Step Therapy Program

The prior authorization/step therapy program is designed to encourage safe, cost-effective medication use.

This program may be part of your prescription drug benefit plan. To find out if your specific benefit plan includes the prior authorization/step therapy program, and which drugs are part of your plan, refer to your benefit materials, or call the number on the back of your ID card.

Prior Authorization

Under this program, your doctor will be required to request pre-approval, or prior authorization, through Blue Cross and Blue Shield of Montana in order for you to get benefits for the select drugs.

  • Examples of drug categories and specific medications for which a prior authorization program may be included as part of your prescription drug benefit plan are listed below.
  • Please note that not all drug categories are included in all benefit plans. Additional drug categories may be added and the medications listed are only examples. Call the number on the back of your ID card with questions about a specific medication.
  • If you are taking, or prescribed, a drug that is newly introduced to the market on or after October 1, 2015, you may need to have your doctor submit a prior authorization request in order to get benefits for such drugs. If you have questions about your medicine, call the number on the back of your ID card.
  • As always, cost is only one factor in choosing medication and treatment decisions are between you and your doctor.

Step Therapy

The step therapy program requires that you have prescription history for a "first-line" medication before your benefit plan will cover a "second-line" drug.

  • A first-line drug is recognized as safe and works well in treating a specific medical condition, as well as being a cost-effective treatment option.
  • A second-line drug is a less-preferred or likely a more costly treatment option.

Step 1: If possible, your doctor should prescribe a first-line medication right for your condition.

Step 2: If you and your doctor decide that a first-line drug is not right for you or is not as good in treating your condition, your doctor should submit a prior authorization request for coverage of the other drug.

  • Below are examples of drug categories and specific medications for which a step therapy program may be included as part of your prescription drug benefit plan.
  • Step therapy does not apply to the generic equivalents for these medications (if available), so if you and your doctor decide the generic equivalent is best for you, prior authorization is not required.
  • These medications are listed along with the first use approved by the U.S. Food and Drug Administration, but may be prescribed for conditions other than those noted and would still be part of the step therapy program.
  • Please note that not all drug categories are included in all benefit plans. Additional categories may be added and the medications listed are only examples. Call the number on the back of your ID card with questions about a specific medication..
  • As always, cost is only one factor in choosing medication and treatment decisions are between you and your doctor.

If you have questions about the prior authorization/step therapy program, call the number on the back of your BCBSMT ID card.

Specialty Pharmacy Program

Your prescription drug benefit may include a specialty pharmacy program through Prime Therapeutics Specialty Pharmacy (Prime Specialty Pharmacy).

Specialty medications are those used to treat serious or chronic conditions. Examples include hepatitis C, hemophilia, multiple sclerosis, and rheumatoid arthritis. These drugs are typically given by injection, but may be topical or taken by mouth. They often require careful adherence to treatment plans, have special handling or storage requirements, and may not be stocked by retail pharmacies.

View the Specialty Pharmacy Program Drug List , which includes a reminder about coverage for self-administered specialty medications.

When you purchase specialty medications through Prime Specialty Pharmacy, you can have your self-administered specialty medications delivered directly to you, or to your doctor's office. You also receive at no additional charge:

  • Support services for managing your drug therapy
  • Educational materials about your particular condition
  • Help with managing potential medication side effects
  • 24/7/365 customer service phone access

BCBSMT members who use oral oncology or hemophilia specialty drugs may have other in-network specialty pharmacy options. Log in to your Blue Access for MembersSM account to find a preferred specialty pharmacy near you.

Note: Prime Therapeutics Specialty Pharmacy LLC (Prime Specialty Pharmacy) is a wholly owned subsidiary of Prime Therapeutics LLC, a pharmacy benefit management company. Blue Cross and Blue Shield of Montana (BCBSMT) contracts with Prime Therapeutics to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. BCBSMT, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.

Mail Service Program

Mail Order Pharmacy Services

It is recommended that you use mail order services to fill your maintenance or long-term prescriptions in order to reduce your out-of-pocket costs. Depending on your pharmacy benefit, using mail order services can provide more medication at a reduced cost. You can obtain up to a 90-day supply of long-term (or maintenance) medications. Maintenance medications are those drugs you may take on an ongoing basis to treat conditions such as high cholesterol, high blood pressure or diabetes. View the Maintenance Drug List  to see if your medication is included. Short-term prescriptions, such as a 10-day prescription for antibiotics or acute pain medications, should be filled at your local retail pharmacy.

PrimeMail®

PrimeMail is an additional feature through Prime Therapeutics that offers our members prescription mail order services. PrimeMail is located in Albuquerque, New Mexico.

When you log in to Blue Access for MembersSM and visit your Rx Drugs page, you can use the online order form, print an order form to mail or ask that PrimeMail get in touch with your doctor to request a new prescription.

Ridgeway Pharmacy

Ridgeway Pharmacy, located in Victor, Montana, is an independent company that provides mail order prescriptions to our members.

Visit the Ridgeway Pharmacy website Learn more about third-party links for more information.

Vaccine Program

If you have coverage through Blue Cross and Blue Shield of Montana (BCBSMT), vaccinations may be covered under the medical benefit or prescription drug benefit, based on your plan. Select vaccines can be conveniently administered at a pharmacy near you. These vaccines can help protect you and your covered family members from illnesses such as the flu, pneumonia, shingles, meningitis, HPV, rabies, hepatitis B, diphtheria, pertussis and tetanus.

To see which vaccines are covered under your plan, check your benefit materials for details and any necessary copays. Or, you can call the Pharmacy Program number on the back of your ID card.

  • The select vaccines covered under the prescription drug benefit are conveniently administered at a participating vaccine network pharmacy. Just hand your ID card to the pharmacist.
  • To see a complete list of all participating pharmacies, pharmacies, log in to Blue Access for Members and select Prescription Drugs from the Quick Links section on the right-hand side. Or, you can call the number on the back of your ID card.
  • Before you go, be sure to confirm the location’s participation and hours, vaccine availability and ask about any other age limits, restrictions or requirements that may apply.