May. 10, 2021
Blue Cross and Blue Shield of Montana (BCBSMT) has chosen new mail order and specialty pharmacy service providers through our pharmacy benefit manager (PBM), Prime Therapeutics LLC (Prime).
As of May 1, 2021, BCBSMT members, whose pharmacy benefits are administrated through Prime, now have Express Scripts® Pharmacy for mail order services and Accredo® (a full-service specialty pharmacy) for related services. Based on the member’s benefit plan, other in-network pharmacies may be available.
These vendor changes apply for commercial group and retail plan members. Please note: Your Medicare Part D patients will have these added choices starting August 1, 2021. They may ask you to move their prescription(s) to one of these new pharmacy services at that time.
A summary of the new pharmacy services offered and any action you may need to take is listed below.
Mail Order Services
Some of your patients will have a new mail order pharmacy and/or a new choice to fill covered 90-day supply maintenance medicines, Express Scripts® Pharmacy. Mail order service provides a convenient way for your patients to get up to a 90-day supply of a maintenance (or long-term) medicine by mail.
- There is no urgent action you need to take. If your patients have existing mail order prescriptions, the prescriptions may have been sent to Express Scripts® Pharmacy on May 1.
- After May 1, some of your patients may ask you to send a new prescription to Express Scripts® Pharmacy. These patients may be new to mail order or did not have their prescriptions move and wish to keep using a mail order service. Some prescriptions that will not transfer are controlled substances, medicines regulated by a REMS (Risk Evaluation and Mitigation Strategy) program, expired prescriptions or prescriptions with no refills left as of May 1.
- When renewing your patients’ current maintenance prescriptions or when writing new prescriptions for mail order, you can send them to Express Scripts® Pharmacy:
- Electronically – Use your EMR system to e-prescribe to: Express Scripts Home Delivery. For questions on e-prescribing, call 1-800-211-1456, option 5.
- By Fax – Call 888-327-9791 for faxing instructions. (Faxes can only be received from a doctor’s office.)
- By Phone – Call the pharmacy at 833-715-0942 for commercial group and retail plan members.
- About Express Scripts® Pharmacy:
- With a thorough validation process, the pharmacy has a 99.99% dispensing accuracy and more than 30 years of prescription home delivery experience.
- Pharmacists leverage their clinical knowledge and experiences to review for possible drug therapy issues and address adherence gaps.
- There are many locations across the US, allowing for fast processing and dispensing with no added cost for standard delivery.
- Support staff are on hand 24 hours a day, 7 days a week to help with any medicine questions or concerns.
- Members can use digital tools to refill prescriptions, track orders, set reminders to take medicine(s) and more.
- For more information on Express Scripts® Pharmacy, visit express-scripts.com/rx.
Specialty Pharmacy Services
Some of your patients will have Accredo as a new choice to get specialty drugs covered under the pharmacy benefit. Accredo provides patients with access to specialty drugs, as well as personalized care and dedicated clinical resources to help them manage their health condition(s).
BCBSMT members should use an in-network specialty pharmacy to take full advantage of their pharmacy benefit coverage. Based on a member’s benefit plan, there may be other in-network options. Please note: Specialty pharmacies used to supply specialty drugs covered under the member’s medical benefit are not affected and can still be used.
- There is no urgent action you need to take. If your patients have existing pharmacy benefit specialty drug prescriptions, the prescriptions may have been sent to Accredo on May 1.
- After May 1, some of your patients may ask you to send a new prescription to Accredo. These patients may be new to specialty drug treatments or did not have their prescriptions move and wish to keep using an in-network specialty pharmacy. Some prescriptions that will not transfer are controlled substances, expired prescriptions or prescriptions with no refills left as of May 1.
- When renewing your patients’ current specialty drug prescriptions or when writing new prescriptions, you can send them to Accredo. To get started, visit accredo.com/prescribers for referral forms by therapy, e-prescribe to Accredo1 or call the pharmacy at 833-721-1619 for commercial group and retail plan members.
- About Accredo:
- You and your patients have access to a team of 500 condition-specific pharmacists and more than 600 nurses with extensive training and experience.
- Staff support one of 15 Therapeutic Resource Centers® (TRCs), each focused on a specific specialty condition, and are on hand 24 hours a day, 7 days a week to help answer questions.
- Through one-on-one counseling, personal support and routine contact, your patients are encouraged to stick to their treatment regimens for the best results. Accredo may reach out to you at times to coordinate care.2
- The pharmacy has broad access to specialty drugs, including many with limited distribution, with no added cost for standard delivery.
- Accredo aims to provide a simple member experience, through a member’s preferred means of communication (phone call, email, texting, mobile app and/or online member website).
- Providers have varied support tools, such as physician concierge, e-prescribe, ePA and interoperability with EHRs.
- You have visibility to the status for all of your Accredo patients through Accredo’s prescriber portal at , where you can:
- See patient referrals, refills and renewals
- Flag patients or prescriptions for follow-up
- Check on prior authorizations
- Track prescriptions as they’re processed and filled
- For more information about Accredo, visit accredo.com/prescribers.
1 eRx to NCPDP ID 4436920, 1640 Century Center Parkway, Memphis, TN 38134
2 Treatment decisions are between you and your patient.
Please take this opportunity to update any pharmacy information that may be stored in your patients’ records. Also, if your patient had a current benefit prior authorization approval on file, it will follow the standard BCBSMT process for renewals.
Members can call us at the number listed on their BCBSMT Member ID card if they have any questions. They can also log in to their Blue Access for MembersSM (BAMSM) account on bcbsmt.com for online resources. If you have any questions, need further help or need to check a patient’s coverage, please call us at the number on your patient’s ID card.
Express Scripts® Pharmacy is a pharmacy that is contracted to provide mail pharmacy services to members of Blue Cross and Blue Shield of Montana (BCBSMT). The relationship between Express Scripts® Pharmacy and BCBSMT is that of independent contractors. Express Scripts® Pharmacy is a trademark of Express Scripts Strategic Development, Inc.
Accredo is a specialty pharmacy that is contracted to provide services to members of Blue Cross and Blue Shield of Montana (BCBSMT). The relationship between Accredo and BCBSMT is that of independent contractors. Accredo is a trademark of Express Scripts Strategic Development, Inc.
Prime Therapeutics LLC is a separate pharmacy benefit management company contracted by BCBSMT to provide pharmacy benefit management and related other services. BCBSMT, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.
Blue Cross®, Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.
Pharmacy benefits and limits are subject to the terms set forth in the member’s certificate of coverage which may vary from the limits set forth above. For more complete details, including benefits, limitations and exclusions, members should refer to their certificate of coverage. Regardless of benefits, the final decision about any medication and pharmacy choice is between the member and their health care provider.