Blue Review
A newsletter for contracting institutional and professional providers

September 2017

Integration of Prime Therapeutics® and Walgreens® Specialty Pharmacy and Mail Order Services

Blue Cross and Blue Shield of Illinois (BCBSIL)’s pharmacy benefit manager (PBM), Prime Therapeutics LLC (Prime), and Walgreens announced a strategic alliance in August 2016 to create a first-of-a-kind model for pharmacy benefit management that aligns a national pharmacy chain, a leading PBM and health plans, including a long-term retail pharmacy agreement. As part of this alliance, Prime and Walgreens have formed a combined company for specialty pharmacy and mail order services, headquartered in Orlando, FL.

Teams have been working to unite each organization’s mail service and specialty pharmacy operations. As of mid-August 2017, all BCBSIL members whose pharmacy benefits are administrated through Prime will have been integrated into the new combined company’s pharmacy systems.1 A summary of the changes you might experience from this integration is included below for your reference.

Specialty Pharmacy Services
As of June 3, 2017, BCBSIL members were integrated into the new specialty pharmacy system. The new company is nationally accredited by Accreditation Commission for Health Care (ACHC) and URAC. Any additional accreditation and licenses will be pursued as needed. Additionally, a vast selection of previously labeled limited distribution products will be available through Prime Therapeutics Specialty Pharmacy (Prime Specialty Pharmacy).

There are no changes to the way you submit a prescription. The following remains the same:

  • The name used when e-prescribing – Prime Therapeutics Specialty
  • The benefit prior authorization process – Patient benefit prior authorization approvals on file were transferred and will follow the BCBSIL process for renewals
  • The number you call to reach Prime Specialty Pharmacy – 877-627-MEDS (6337)
  • The hours of operation – Monday through Friday, 8 a.m. to 8 p.m., ET

For prescriptions coming to your location, you may notice changes in Prime’s communications and packaging, including:

  • The use of the Prime Specialty Pharmacy and Walgreens names/logos may both appear on the packing receipt, enclosed information sheets, stickers on the box, etc.
  • Cooler/cooler packaging and the box holding the medicine may look different
  • The label affixed to the front of the box may show a dispensing location other than Orlando, FL

Mail Order Services
Covered 90-day supply mail order prescriptions are being filled by the PrimeMail by Walgreens Mail Service home delivery program as of July 1, 2017.

There is a new way to submit a prescription electronically:
For patients with expired/no remaining refill prescriptions, you will need to provide a new prescription. If submitting this prescription electronically after July 1, 2017, you will need to send it to Walgreens Mail Service in Tempe, AZ, or you can fax the prescription to 800-332-9581.

Please Note: Existing PrimeMail e-prescribing or fax methods you may be using currently can continue to be used for the immediate future but will be returned as “unable to fill” at some point later this year. 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 was transferred over to the new mail order system and will follow the standard BCBSIL process for renewals.

Members with prescription history within the last 12-18 months were notified of the specialty pharmacy and/or mail order service changes. Full integration of all mail service and specialty pharmacy services is expected to be completed by the first quarter of 2018. More information about the new combined company, including the official name, will be shared in future Blue Review issues and/or in the News and Updates section of our Provider website.

If your patients have questions about their pharmacy benefits, please advise them to contact the Pharmacy Program number on their member ID card. Members may also visit bcbsil.com and log in to Blue Access for MembersSM (BAMSM) for a variety of online resources.

1Members with Medicare Part D or Medicaid coverage transitioned to the new mail order services as of earlier this year.

Prime Therapeutics LLC is a pharmacy benefit management company. BCBSIL contracts with Prime Therapeutics to provide pharmacy benefit management and other related services. In addition, contracting pharmacies are contracted through Prime Therapeutics. The relationship between BCBSIL and contracting pharmacies is that of independent contractors. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.

Prime has entered into an agreement with Walgreens, an independently contracted pharmacy, to form a combined specialty pharmacy and mail order services company, owned by Prime and Walgreens.

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.