June 16, 2021

Pharmacy Member Communications to be Sent for New Specialty and Mail Order Pharmacy Services

As previously communicated on May 5, our pharmacy benefit manager (PBM), Prime Therapeutics^®, signed an agreement to provide its health plan clients, including Blue Cross and Blue Shield of Texas (BCBSTX), another home delivery (mail order) and specialty pharmacy option.

Beginning Aug. 1, 2021, we are adopting:

• Express Scripts^® Pharmacy for mail order
• Accredo^® for specialty pharmacy services

As a reminder, this change will apply for our employer group, retail, Medicare and Medicaid plans. For our Medicare and Medicaid plans, members will have these pharmacy services added to their network as available options.

Member support: To create a seamless transition, group and retail members with active specialty drug or mail order prescriptions currently being filled at AllianceRx Walgreens Prime will be automatically transferred to Accredo or Express Scripts^® Pharmacy, starting Aug. 1, 2021.

A few items to note:
 

• If the prescription has remaining refills and can be filled at the new pharmacy, members will not be required to do anything until on or after Aug. 1.
   
• Some prescriptions cannot be transferred, such as prescriptions for controlled substances or a prescription that has expired or has zero refills remaining. In these cases, the member may still be sent an awareness communication saying they will need to have a new prescription sent to the new pharmacy on or after Aug. 1.
   
• With the change to Accredo for specialty pharmacy services, there are some members whose prescription will not transfer (i.e., the drug is not considered “specialty” under the pharmacy benefit) and some members whose drug is now available to be filled at Accredo (i.e., specialty drugs that were not being filled at AllianceRx Walgreens Prime due to limited availability). Awareness communications may be sent to members that fall into these situations.
   
• To protect member privacy, only the member’s prescription information and minimal member profile information will be sent to the new pharmacies. During the onboarding process, members will need to provide additional profile information to complete an initial fill request, such as a credit/debit card, language and communication channel preferences, delivery instructions, etc.
   
• At Accredo, members will be managed by a dedicated onboarding support team who will assist them in registering and completing their first fills after Aug. 1.

Member notices: Starting late June 2021, our group and retail plan members will begin receiving the following communications related to this pharmacy service transition:
 

• Based on claims files, transitioning members will receive initial communication via a letter arriving in-home 30 days prior to the Aug. 1 implementation date. This communication will alert them of the change, provide them with steps they need to take on or after Aug. 1, and what they can expect.
   
• Review sample letters that will be sent to affected members:
• Home Delivery (mail order) transition 
• Specialty transition 
• Limited Distribution (LD) specialty drugs  – Exclusive specialty benefit members who were not filling at AllianceRx Walgreens Prime specialty due to limited availability, but the specialty drug(s) will now be available to fill at Accredo.
• “Non-Specialty” drug utilization  – Members who were filling a drug at AllianceRx Walgreens Prime specialty that was not considered “specialty” under the pharmacy benefit; these members will need to fill their prescription(s) at a retail pharmacy, or home delivery if benefits allow.

• The member awareness letters include links to a dedicated landing page on the Accredo and Express Scripts^® Pharmacy websites. These landing pages, which are available when the letters mail, provide members with FAQs and other info to prepare them for the pharmacy service transition.
   
• Members will also see revised copy on the Prime member portal, MyPrime.com , both logged in or pre log-in, starting one month prior to the transition.
   
• Additional communications will be provided via the bcbstx.com website, fliers, brochures, updated benefit materials and various other communication channels to reinforce this information.
   
• Targeted outreach to members with new prescriptions received after the initial communication mailing may be completed pre- and post-implementation to ensure continuity.

Questions? If you have any questions about this pharmacy services transition, including member impact, please contact your BCBSTX representative.

This information applies to members and groups with prescription drug benefits administered through Blue Cross and Blue Shield of Texas (BCBSTX).

BCBSTX contracts with Prime Therapeutics to provide pharmacy benefit management and related other services. 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. Prime Therapeutics has an ownership interest in AllianceRx Walgreens Prime, a central specialty and mail order pharmacy.

Accredo is a specialty pharmacy that is contracted to provide services to members of BCBSTX. The relationship between Accredo and BCBSTX is that of independent contractors. Accredo is a trademark of Express Scripts Strategic Development, Inc.

Express Scripts^® Pharmacy is a pharmacy that is contracted to provide mail pharmacy services to members of BCBSTX. The relationship between Express Scripts^® Pharmacy and BCBSTX is that of independent contractors. Express Scripts^® Pharmacy is a trademark of Express Scripts Strategic Development, Inc.

Express Scripts is an independent company and is solely responsible for the products and services that it provides.

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.