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Prime Therapeutics: New PBM as of April 1

Blue Cross and Blue Shield of North Carolina’s (BCBSNC’s) commercial membership will have a new pharmacy benefits manager (PBM), Prime Therapeutics (Prime), as of April 1, 2012.  We expect to have minimal changes in the number of pharmacies participating in our network, which will also limit disruption of pharmacy services for our members.

Prime is in the process of finalizing their nationwide pharmacy network on our behalf, and in early February, we will contact those pharmacies that have not yet joined the new network to encourage them to accept Prime’s invitation. 

Our current PBM, Medco, is notifying BCBSNC members in their mail-order program that their next 90-day refill (if refill date is on or after April 1) will not be covered by Medco.  We wanted you to be aware of this communication since you may receive questions from BCBSNC patients.  Prime’s new member materials are scheduled to begin mailing to members in late February.  We have provided a scripted message on our customer service line to help ease members’ concerns as a result of the Medco communication.

Key Points to Know About Prime

  • All pharmacy prior authorizations and patient medication history currently on file with Medco will automatically transfer to Prime Therapeutics (except controlled substances)
  • Prime will contact physicians with BCBSNC commercial members who have controlled substance prescriptions in order to have the script replaced.
  • In the unusual event that Prime doesn’t receive a BCBSNC patient’s record, Prime will work with the sending pharmacy and member to transfer or obtain a new prescription as quickly as possible to avoid any interruption in care.
  • The change to Prime Therapeutics as our new PBM only applies to our commercial group and individual business (excludes Blue Medicare products and the Federal Employee Program).
  • The State Health Plan will remain with Medco as their PBM.
  • Members who will have Prime as their PBM will receive new ID cards in March.
  • PrimeMail®  will replace Medco’s Worry-Free® mail-order program

We will provide you with more information about PrimeMail and other Prime updates in March.  If you have any questions, please contact your BCBSNC Network Management representative or BCBSNC Customer Service.