August 19, 2016

Prime Pharmacy Network Change Effective Jan. 1, 2017 for Fully Insured Group and Retail Market Plans

Effective Jan. 1, 2017 (regardless of renewal date), CVS pharmacies and CVS pharmacies in a Target store will no longer be a part of Blue Cross and Blue Shield of Illinois’ (BCBSIL) standard pharmacy network for members with pharmacy benefits administered by Prime Therapeutics^®.

This network change impacts fully insured group and retail market (Metallic plan small group and individual) members. It does not impact all BCBSIL HMO plans, and Medicaid or Medicare plans, at this time.

ASO groups have the choice to either adopt this revised pharmacy network with CVS excluded or remain with the current pharmacy network that includes CVS. Contact your BCBSIL representative for more information.

Working closely with Prime Therapeutics, BCBSIL continuously assesses our pharmacy networks and offerings to ensure we are maintaining affordable benefits for our members, including obtaining competitive reimbursement rates from participating pharmacies within Prime’s network. Through ongoing negotiations, CVS Pharmacy requested a higher reimbursement rate for generic prescriptions as compared to other pharmacies. Therefore, BCBSIL has made the decision to no longer include CVS pharmacies within the pharmacy network.

Members will continue to have access to more than 55,000 nationwide pharmacies in network (without CVS), with more than 1,800 located within Illinois. This includes many major pharmacy chains such as Walgreens, Walmart, Albertsons (including Osco Drug), Kroger, Rite Aid and many independent pharmacies. In every county where we have a presence, we exceed network adequacy standards set by Illinois with the remaining pharmacies in network.

Additionally, BCBSIL offers retail market members affordable options through our 2016 Preferred Pharmacy Network, including as low as $0 copays. This network includes more than 1,100 pharmacies, with at least one major national chain, a grocery chain and many independent pharmacies.

BCBSIL is committed to helping our members find the most convenient alternative for their pharmacy coverage needs. Impacted members, who have had a recent CVS claim, will be notified in October with a letter. This letter will provide information on how to find an alternative network pharmacy as well as how to transfer any current refill/new prescriptions to their new pharmacy.

Stay tuned for more information about this pharmacy network change. If you have any questions, contact your BCBSIL representative.

BCBSIL contracts with Prime Therapeutics to provide pharmacy benefit management, prescription home delivery and specialty pharmacy 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.