August 2017 
 
Integration of Prime Therapeutics^® and Walgreens^® Specialty Pharmacy and Mail-Order Services
 
The Blue Cross and Blue Shield of New Mexico (BCBSNM) 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. This new model aligns a national pharmacy chain, a leading PBM and health plans, and includes a long-term retail pharmacy agreement. As part of this alliance, Prime and Walgreens have formed a yet to be named combined company for specialty pharmacy and mail-order services, headquartered in Orlando, FL. This new company is nationally accredited by the Accreditation Commission for Health Care (ACHC) and URAC.

Current prior authorization approvals on file for mail-order or specialty prescriptions will be transferred over to the new systems and will follow the standard BCBSNM 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. All BCBSNM members whose pharmacy benefits are administered through Prime will be integrated into this new combined company’s systems by mid-August, 2017.¹

It is important to understand what changes will be occurring so providers will be ready as services change over:
Changes to Specialty Pharmacy Services

For prescriptions coming to your location, there may be changes in Prime Therapeutics’ communications and packaging:

• The use of both Prime Therapeutics Specialty Pharmacy (Prime Specialty Pharmacy) and Walgreens names and logos may appear on packaging and informational materials.
• Shipping materials, coolers, and cooler packaging may change in appearance.
• Shipping labels may show a dispensing location other than Orlando, FL.

A vast selection of previously labeled limited-distribution products will also now be available through Prime Specialty Pharmacy. There are no changes to the way you submit a prescription, and the contact information for Prime Specialty Pharmacy remains the same.

Changes to Mail-Order Services

As of August 18, 2017, covered 90-day supply mail-order prescriptions will be filled by PrimeMail by Walgreens Mail Service home delivery program.

Providers will need to submit a new prescription for patients with expired or no remaining fill prescriptions. Providers will need to fax prescriptions to 800-332-9581 or send electronic prescriptions to Walgreens Mail Service in Tempe, AZ.

Please note: Existing PrimeMail, ePrescribing or fax methods may be used for the immediate future, but will be returned as “unable to fill” by the end of the year. Please take this opportunity to update any pharmacy information that may be stored in your patient records.

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 bcbsnm.com and log in to Blue Access for Members^SM (BAM) for a variety of online resources.

¹ Members with Medicare Part D or Medicaid coverage transitioned to the new mail-order services as of February 1, 2017.

Prime Therapeutics LLC is a pharmacy benefit management company. BCBSNM 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 BCBSNM and contracting pharmacies is that of independent contractors. BCBSNM, 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.

The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Physicians are to exercise their own medical judgment. 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. This is only a brief summary of some plan benefits. 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.

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.