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 (BCBSMT) in order to get benefits for you for select drugs.


    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.


    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

    Specialty medications are those used to treat serious or chronic conditions. Examples include hepatitis C, hemophilia, cancer, multiple sclerosis and rheumatoid arthritis. They often call for carefully following a treatment plan (or taking on a strict schedule), have special handling or storage needs, and may only be stocked by select pharmacies. More information is available in the specialty pharmacy program member flier.

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

    A split fill program may apply to some specialty medications like select oral oncology (cancer) drugs. This program lets you try the medication first to make sure you can tolerate any potential side effects. You will get a partial fill of your prescription and only pay for what was filled (a prorated cost of your benefits).

    Coverage benefits and requirements may vary based on your plan benefits. Call the number on your member ID card if you have any questions.

    To order through Accredo:

    • For new prescriptions — Ask your doctor to call in your prescription to 1-833-721-1619 or e-prescribe your prescription to Accredo. Your doctor can find e-prescribing information on their website.
    • For existing prescriptions — You can request a transfer of your existing prescription for a specialty medication by calling 1-833-721-1619.

    A patient care advocate will work with you and your doctor to confirm your order, mailing address and arrange delivery of your covered medications.

    When you purchase specialty drugs through Accredo, 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:

    • One-on-one support and counseling from 500+ condition-specific pharmacists and 600+ nurses
    • Simple communication, including refill reminders, by your choice of phone, email, text or web
    • An online member website and mobile app to help you manage your prescriptions
    • 24/7/365 support and free standard shipping


    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.

    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.

  • 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.

    Express Scripts® Pharmacy

    Express Scripts® Pharmacy, a mail order pharmacy for members with BCBSMT prescription drug coverage, provides safe, fast and cost-effective pharmacy services that can save you time and money.

    Getting Started Online

    You have more than one option to fill or refill a prescription online or from a mobile device:

    • Visit express-scripts.com/rx. Follow the instructions to register and create a profile.
    • Log in to myprime.com  and follow the links to Express Scripts® Pharmacy.

    Order Over the Phone

    Call 1-833-715-0942, 24/7, to refill, transfer a current prescription or get started with home delivery. Please have your member ID card, prescription information and your doctor’s contact information available.

    Through the Mail

    To send a prescription order through the mail, log in to Blue Access for MembersSM. Complete the mail order form. Mail your prescription, completed order form and payment to Express Scripts® Pharmacy.

    For more information, download the Express Scripts® Pharmacy flier.

    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 for more information.

  • Vaccine Program


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

    To learn more about which vaccines are available under your plan for you and your covered family members, check your benefit materials for details and any necessary copays. Or, you can call the phone number listed on your member ID card.

    • For vaccinations covered under the prescription drug benefit, select vaccines can be conveniently administered at a participating vaccine network pharmacy near you. Just hand your member ID card to the pharmacist.
    • To see a complete list of all participating pharmacies, search the pharmacy network on myprime.com and filter for vaccine pharmacies. 
    • 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.


    More information is available in the pharmacy vaccine program member flier.
     

  • Pharmaceutical Care Management


    If you have BCBSMT prescription drug benefit coverage, you have access to our team of clinical pharmacists and other resource tools to help answer questions you may have about your prescriptions.

    The Pharmaceutical Care Management (PCM) program helps you get the best results from the medicines you take. A member of the PCM team may reach out to talk with you about the medicines you take. The medication review by a clinical pharmacist helps make sure the medicines you are taking are safe and work well. The pharmacist can also share ways to help you lower your out-of-pocket costs for your prescriptions.

    For more information about how PCM works: