2017 Prescription Drug Benefit Changes

If you have a non-grandfathered health plan offered by your employer, some changes may be made to your prescription drug benefit through Blue Cross and Blue Shield of Oklahoma (BCBSOK). Starting January 1, 2017, or on your group's 2017 renewal date, you may be affected by one or more of these changes:

Drug List Changes*

Some members’ benefits will be based on a new drug list on their 2017 renewal date:

Performance Drug List

Some members’ benefit plans will be based on the Performance Drug List.

  • If this applies to you, all available covered drugs are shown on the printed list. Drugs that are not shown are not covered.
  • If you are taking or are prescribed a drug that will no longer be covered, ask your doctor about therapeutic alternatives. Your doctor can also request a formulary coverage exception from BCBSOK (unless you have a benefit exclusion).
  • You can view a list of commonly used drugs that will no longer be covered and their alternatives PDF Document. Or, you can view a list of drugs that will be excluded PDF Document.
  • Some drugs may move to a higher payment level tier. These drugs may still be eligible for coverage, but you may pay a higher copay or coinsurance amount, based on your benefit plan.
  • If you are taking or are prescribed one of the drugs affected by these tier changes, ask your doctor if a generic drug or lower-cost alternative drug is right for you. Depending on your prescription drug benefit, these drugs may cost you less.
  • You can view the full list of drugs that are being moved PDF Document.

Enhanced (Generics Plus) Drug List

Some members' benefit plans will be based on the Enhanced (formerly known as Generics Plus) Drug List.

  • If this applies to you, some drugs may move to a higher payment level tier. These drugs may still be eligible for coverage, but you may pay a higher copay or coinsurance amount, based on your benefits.
  • If you are taking or are prescribed a drug affected by these changes, ask your doctor if a generic drug or lower-cost preferred alternative drug is right for you.
  • You can view a list of these drugs that will be moved PDF Document.

Refer to your complete drug list by logging in to your account on Blue Access for MembersSM (BAMSM) and selecting Prescription Drugs. The online drug lists are updated at least quarterly. As always, treatment decisions are between you and your doctor.

* Some members' benefits will remain based on the Basic (formerly known as Standard) Drug List and these changes will not apply. Check your benefit materials or call the Pharmacy Program number on the back of the ID card.

Preferred Pharmacy Network

Some members’ benefits may include a new Preferred Pharmacy Network when their plan renews in 2017. If this applies to you:

  • When you fill a prescription for up to a 30-day supply of a covered prescription drug from a retail pharmacy that participates in the Preferred Pharmacy Network, you may pay the lowest copay or coinsurance amount.
  • If you fill a prescription at a non-preferred, in-network pharmacy, you may pay a higher copay or coinsurance amount.
  • You can also fill a prescription for up to a 90-day supply of a covered prescription drug at a preferred pharmacy.
  • Pharmacies participating in the 2017 Preferred Pharmacy Network are:
    • Walgreens
    • Walmart (including Sam’s Club Pharmacy)
    • Pharmacy Providers of Oklahoma, Inc. (PPOk) (a group of independent pharmacies)
    • AccessHealth (a group of independent pharmacies)

See the complete list of preferred pharmacies PDF Document. You can also view this list on myprime.com  by selecting “Preferred Network” and filtering for preferred pharmacies. Please note that changes may be made to the participating pharmacies in the future.

A “preferred” or “participating” pharmacy has a contract with BCBSOK or BCBSOK’s pharmacy benefit manager (Prime Therapeutics) to provide pharmacy services at a negotiated rate. The terms “preferred” and “participating” should not be construed as a recommendation, referral or any other statement as to the ability or quality of such pharmacy.

Pharmacy Network Changes

On January 1, 2017, regardless of renewal date, CVS pharmacies and CVS pharmacies in a Target store are no longer in your pharmacy network. If you fill your prescriptions at a CVS pharmacy after December 31, 2016, you will pay more for your medicine. Based on your benefit plan, you may be eligible for reimbursement. You can submit a prescription drug claim form PDF Document for a covered prescription drug.

Finding a New Pharmacy

  • You’ll still have access to more than 55,000 in-network pharmacies nationwide (without CVS).
  • To find a new in-network pharmacy beginning January 1, 2017, visit myprime.com  and select “Find a Pharmacy”, or call the Pharmacy Program number on the back of your member ID card.

Switching Current Prescriptions

Once you find a new in-network pharmacy, you can easily transfer your prescriptions by doing one of the these:

  1. Take your prescription bottle/bag to your new pharmacy. They can contact your current pharmacy to transfer your prescription.
  2. Call your new pharmacy and ask them to contact your current pharmacy for your prescription information.
  3. Ask your doctor to contact your new pharmacy with your prescription information.

Moving to Home Delivery

If you take any long-term medicine(s), consider using the PrimeMail® home delivery service to help you save time and money. Up to a 90-day supply of your covered prescriptions can be shipped to you anywhere in the U.S., with free standard shipping. To choose home delivery:

  1. Register and/or sign in to myprime.com  and click on “Fill with PrimeMail”.
  2. Go to “Transfer to PrimeMail” and click on “Fill with PrimeMail”.
  3. Or, you can call PrimeMail at 800-423-1973 to transfer your prescription.

Filling New Prescriptions

  • Be sure to ask your doctor to send any new prescriptions to your new pharmacy.
  • Show the pharmacist your member ID card when you visit your new pharmacy for the first time.

Utilization Management Programs

Your prescription drug benefit includes prior authorization (PA), step therapy (ST) and dispensing limit (DL) programs. These programs promote safe and proper use of medicines.

For types of drugs that may be included in these programs and more information, visit:

Member Pay the Difference Program

Some BCBSOK prescription drug benefit plans have a Member Pay the Difference Program. The program makes sure members use medicines that are safe, work well and are cost-effective. When you fill a prescription for a covered brand-name drug when a generic equivalent is available, you may pay more.

You will pay your brand copay/coinsurance amount plus the difference in cost between the brand and generic equivalent. Your pharmacist can often substitute a generic equivalent for its brand counterpart without a new prescription from your doctor. But only you and your doctor can decide if a generic alternative is right for you. All member pay the difference costs that you may pay will not count toward your total out-of-pocket costs.

Check your benefit materials to see if your benefit plan includes the Member Pay the Difference Program. If you have any questions, call the Pharmacy Program number on the back of your ID card.

What should I do?

If you are taking, or are prescribed, a drug that may be affected by any of these changes, please talk to your doctor now.

Remember: Pharmacy choices and treatment decisions are always between you and your doctor. Only you and your doctor can decide which medicine is right for you. Talk with your doctor, or pharmacist, about any questions or concerns you have about medicines you are prescribed. Coverage is based on the limitations and exclusions of your benefit plan. Some drugs may call for members to meet certain criteria before prescription drug benefit coverage may be approved. See your plan materials for details.

If you have any questions, call the Pharmacy Program number on the back of your ID card.