Oct. 26, 2016

Jan. 1, 2017 Prime Pharmacy Network Change Member Communications to Be Released

As previously communicated, CVS pharmacies and CVS pharmacies in a Target store will no longer be a part of Blue Cross and Blue Shield of Texas’ (BCBSTX) pharmacy network for members with pharmacy benefits administered by Prime Therapeutics. This change is effective Jan. 1, 2017 (regardless of renewal date) for most groups (Metallic/QHP small group and non-Administrative Service Only fully insured), as well as Retail individual members. It does not impact all Medicaid or Medicare plans, at this time.

Member impact letters are being sent this week:

• Members with the Preferred Pharmacy Network as part of their benefit plan, either currently or in Q1 2017, will receive a letter highlighting the next three closest preferred pharmacies.

• All other insured members will move to Prime’s Advantage pharmacy network, which excludes CVS. The letter highlights the next three closest in-network pharmacies.

Please note: These same letters will be sent in early January to members with a new CVS claim following this initial mailing. Stay tuned for more information about this pharmacy network change. If you have any questions, contact your BCBSTX representative.

BCBSTX 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 BCBSTX and contracting pharmacies is that of independent contractors. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.