Aug. 9, 2023
Applies to all groups
Reminder: As previously mentioned, MedsYourWay became available for most fully insured Group plans in Texas with Prime® as their pharmacy benefit manager (PBM) as of June 1, 2023. Starting Jan. 1, 2024, regardless of renewal date, it will be implemented for Cost Plus, Blue Balance FundedSM and ASO Group plans.
Since launching the program April 1, 2023, for our Individual & Family Market and small group plans, members have been saving about $15.00 per claim.
What’s new: As MedsYourWay becomes available for the plans noted above, ASO and Cost Plus groups with off-cycle renewals may not have updated pharmacy benefit manager (PBM) addendum and benefit program application (BPA) language that reflects some MedsYourWay program nuances until their renewal date later in 2024.
The new BPA/PBM addendum language will read:
“MedsYourWay program claims will be included in calculation of the discount and Dispensing Fee pricing guarantees. MedsYourWay is the embedded drug discount card comparison program utilized where available and applicable to Employer, Network Pharmacy, and the Covered Drug.”
Why does this matter? Claims processed through a MedsYourWay drug discount card vendor will be included in client financial guarantees effective Jan. 1, 2024, regardless of renewal date.
Action Required: Inform your ASO and Cost Plus group customers of the financial guarantee management approach for MedsYourWay. If an ASO customer is concerned with this approach, they can opt out of MedsYourWay. They must reach out to their Blue Cross and Blue Shield of Texas (BCBSTX) representative to submit the custom request by Dec. 1, 2023.
Marketing Materials: A MedsYourWay employer flier is now available, and a MedsYourWay member flier is coming soon.
Reach out to your BCBSTX representative with any questions and to ask about the fliers.
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.
