Pharmacy Program Quarterly Update, Part 2: Changes Effective April 1, 2023
Applies to all groups, ASO and fully insured
Review the revisions to the drug list for members with prescription drug benefits administered by Prime Therapeutics®.
Member notices: Targeted mailings were sent to members affected by drug list revisions and/or exclusions, prior authorization program and dispensing limit changes.
Blue Cross and Blue Shield of Texas (BCBSTX) contracts with Prime Therapeutics to provide pharmacy benefit management and related other services. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics. MyPrime.comis an online resource offered by Prime Therapeutics.
News from the Blues
News from the Blues
BCBSTX and Medical Center Hospital in Odessa Negotiating New Contracts
Applies to all groups
Blue Cross and Blue Shield of Texas (BCBSTX) and Medical Center Hospital (MCH) in Odessa are negotiating new contracts. If we don’t sign new agreements by June 1, 2023, MCH will leave the following networks:
BCBSTX Extends Contract with Hendrick Health in Abilene to May 31, 2023
Applies to all groups
We’re in active negotiations with Hendrick Health in Abilene. The current contracts were set to expire on April 30, but we’ve extended our contracts to May 31.
The negotiation includes Hendrick Medical Center and Hendrick South in Abilene, as well as Hendrick Health doctors and home healthservices.
We’re working with Hendrick Health to protect our members and customers while providing access to quality care at affordable rates.
More information: For the latest information, visit bcbstx.com/hendrick. Please contact your BCBSTX representative with any questions or concerns.
News from the Blues
News from the Blues
Introducing MyBlueRxTXSM: Mobile Pharmacy App
Applies to all groups What’s new: MyBlueRxTX is a new, personalized digital pharmacy app that makes it easy for members to access, understand and manage their prescription drug care and out-of-pocket costs. It delivers on our commitment to make the digital pharmacy experience easy and intuitive for our members.
Prescription Drug Benefit Update: Introducing MedsYourWay®
Applies to small groups What’s new: MedsYourWay* is a new program that lowers costs for members on select covered drugs at select retail pharmacies. It is an automatic real-time price comparison between prices of participating drug discount cards to the member’s plan cost share completed behind the scenes at select in-network pharmacies. The member pays the lower available price option at check out.
Program details:
Members simply show their BCBSTX member ID at the pharmacy.
MedsYourWay simplifies the brick-and-mortar drug store experience while saving members time and money. It lowers overall prescription costs and helps increase insight into member prescription fills and medication adherence as part of a complete care coordination plan.
MedsYourWay is available now to limited commercial markets. The benefit will be expanded to other commercial markets and New Mexico starting Jan. 1, 2024.
If you have any questions, contact your BCBSTX representative.
*MedsYourWay is administered by Prime Therapeutics®, LLC, a separate pharmacy benefit management company contracted by BCBSTX to provide pharmacy benefit management and related other 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. MyPrime.com is an online resource offered by Prime Therapeutics, LLC.
News from the Blues
News from the Blues
Action Required: Average Monthly Premium Data is Due April 27
Applies to fully insured groups
BCBSTX is assisting our fully insured, Blue Balance FundedSM and Minimum Premium group customers with the Prescription Drug Data Collection (RxDC) Reporting to the Centers for Medicare & Medicaid Services (CMS) for the 2022 reference year. To complete this reporting requirement for our group customers, the account’s benefits administrator must provide us with some information. Zoom in.
News from the Blues
News from the Blues
ASO Group Billing and Fees for Provider Negotiation and Independent Dispute Resolution (IDR) Processes
Applies to ASO groups
A new provider dispute and negotiation process was put in place when provisions of the No Surprises Act (NSA) started for plan years beginning on or after Jan. 1, 2022.
This new, provider-initiated negotiation process, and IDR process—if negotiations fail—is only applicable to NSA-eligible claims. Go deeper.
News from the Blues
News from the Blues
Blue DirectionsSM Webinar: Flexible Solutions for Benefits Management
Applies to mid-market, large groups
Are you looking to simplify benefits administration? Blue Directions gives you access to a wide range of benefits administration solutions, from enrollment to ongoing account administration and reports at no additional cost. Get the details.
News from the Blues
News from the Blues
April Collective Health Webinar — The Employer Experience
Applies to national accounts, ASO and large groups
Looking for a health care program that delivers streamlined benefits to reduce administrative expenses and optimize health outcomes? BCBSTX, in collaboration with Collective Health, invites you to a platform demonstration. See how Collective Health can help ease your burdens with:
Reminder: Multifactor Authentication Is Coming to the Employer Portal
Applies to all groups
Multifactor Authentication (MFA) will go into effect for Blue Access for EmployersSM users in the coming weeks. Learn more.
News from the Blues
News from the Blues
Health & Wellness
News from the Blues
Curious about Taking a Break from Alcohol?
Share the article with your employees
Wonder what taking a break from alcohol can do for your mind and body? Maybe even more than you might think. New research suggests that drinking even modest amounts of alcohol isn’t good for you. You don’t have to have a problem with alcohol to gain health benefits from skipping it.
There are benefits to skipping alcohol for long or short periods any time of the year. That’s because even small amounts of alcohol can have a big effect on your body.From the very first sip, alcohol enters your bloodstream and quickly impacts your body.
Share this article with your employees to learn more about the benefits of giving up alcohol and how to get started.
Texas House Approves 2024-2025 Biennium Budget Bill
The Texas House approved a $302.6 billion budget bill that would earmark funds for state-wide tax cuts and teacher and state employee raises, among other expenditures. It also allots $60.3 billion toward school funding, $79.3 billion for Medicaid and more than $6 billion for non-Medicaid behavioral health services.
March Madness – Texas style: The Texas Monthly magazine asked readers to vote top dog in four Texas brand categories: restaurants, products, stores and wild cards. Hamburger haven Whataburger grilled runner up Dairy Queen. H-E-B supermarket bested Buc-ee’s. Blue Bell held off Dr Pepper, and Southwest Airlines beat Schlitterbahn. H-E-B iced runner-up Blue Bell to be named top Texas brand.
Looking for a Previous Issue of BlueVISIONSM?
You’ll find past issues of BlueVISION on Blue Access for EmployersSM, including a list of articles in each newsletter.
Reminder: Free Wellness Content Available on BlueResourceSM Download and share resources with your employees
BlueResource is a free health and wellness library designed to help members reach better health. Download the articles and other resources you want to share and send them to your employees.
Get started: Log in at 3005brand and create an account. You can customize the content by clicking “Create new artwork.”
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Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation,
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