These Pharmacy Programs are available for HMO members.
These Pharmacy Programs are available for HMO members.
Medications with an equivalent available over-the-counter (OTC) are usually not covered through Blue Cross and Blue Shield of Illinois (BCBSIL) prescription drug plans.
Some facts to consider:
This program does not apply to members who have outpatient prescription drug coverage through their medical plan, processed by BlueSCRIPTSM.
The 90-day supply benefit program can save you both time and money. With this program, you have the option of getting up to a 90-day supply of long-term (or maintenance) medications through a network of contracting extended supply retail and mail service pharmacies. Maintenance medications are those drugs you may take on an ongoing basis to treat conditions such as high cholesterol, high blood pressure or diabetes.
For more information, download the 90-Day Supply Program Member Flier.
1. Ask your doctor for a prescription of a 90-day supply of each of your long-term medicines.
2. To purchase your prescription:
Tips for using mail order:
The Prior Authorization and Step Therapy programs encourage safe, cost-effective medication use. These programs may be part of your prescription drug benefits. Refer to your benefit materials to find out if your benefit plan has these programs, as well as which medications are part of your plan.
This program requires your doctor to request pre-approval, or prior authorization, for you to get benefits for select medications.
The Step Therapy program requires that you use a “preferred” medication before your benefit plan will cover a “non-preferred” medication. The preferred medication is safe, works well in treating a specific medical condition, and is a cost-effective treatment option. A non-preferred medication could be a more costly prescription.
Step 1: If possible, your doctor should prescribe a preferred medication that is right for your condition.
Step 2: If you and your doctor decide that a preferred medication is not right for you, or is not as good in treating your condition, your doctor should submit a step-therapy exception to cover the non-preferred medication. Your doctor can find these request forms at bcbsil.com/provider.
If you have questions about either the prior authorization or the step therapy programs, call the number listed on your member card.
Specialty medications are those used to treat serious or chronic conditions. Examples include hepatitis C, hemophilia, cancer and multiple sclerosis. They often require careful adherence to treatment plans, have special handling or storage needs, and may only be stocked by select pharmacies. More information is available in the specialty pharmacy program member flier.
A split fill program may apply to some medications like select oral oncology (cancer), multiple sclerosis and iron toxicity drugs. This program lets you try the medication first to make sure you can tolerate any potential side effects. You will get a partial fill of your prescription and only pay for what was filled (a prorated cost of your benefits).
Coverage benefits and requirements may vary based on your plan benefits. Call the number on your Member ID card if you have any questions.
BCBSIL HMO members can fill their self-administered specialty drug prescriptions at an in-network specialty pharmacy for pharmacy benefit coverage consideration. To find an in-network specialty pharmacy near you, log in to your Blue Access for MembersSM account and click on the Prescription Drugs link. This will take you to Prime Therapeutics, the pharmacy benefit manager. You can find a list of in-network specialty pharmacies for Illinois HMO members in the Forms section.
If you have BCBSIL prescription drug benefit coverage, you have access to our team of clinical pharmacists and other resource tools to help answer questions you may have about your prescriptions.
The Pharmaceutical Care Management (PCM) program helps you get the best results from the medicines you take. A member of the PCM team may reach out to talk with you about the medicines you take. The medication review by a clinical pharmacist helps make sure the medicines you are taking are safe and work well. The pharmacist can also share ways to help you lower your out-of-pocket costs for your prescriptions.
For more information about how PCM works:
Last Updated: May 08, 2024