Pharmacy Benefit Manager (PBM) Change for BCBS MA Medicare Advantage

Effective Jan. 1, 2023:

The changes listed below apply to all Blue Cross Blue Shield of Massachusetts fully insured members, as well as self-insured members who have pharmacy coverage with us.

Move to CVS Caremark:

Effective Jan. 1, 2023 Blue Cross Blue Shield of Massachusetts will use CVS Caremark, an independent company, to administer pharmacy benefits on our behalf. Express Scripts, Inc. will no longer be our pharmacy benefit manager.

As part the change providers can expect the following:

• Affected members will receive communications regarding any changes and are encouraged to share the information with their provider.
• Active mail order prescriptions will transfer automatically to our members’ new mail order pharmacy:
  • CVS Caremark Mail Service Pharmacy
  • Providers should look for CVS Caremark Mail Order in their e-prescribing tool
• Current prior authorization approvals are valid through their original expiration date.
• The retail specialty pharmacy network is the same as today.
• Blue Cross Blue Shield Massachusetts Pharmacy Operations continues to review and process prior authorization requests.
• CVS Caremark will fax reminders to prescribers for commercial members prior to the expiration of an approved authorizations when the prescriber has listed a fax on their prior authorization.
• New member ID cards will be issued with the updated pharmacy information. Members should share their new ID card with their pharmacy for refills after Jan. 1, 2023.
• Send prescriptions to in-network pharmacies when possible.

Please note that:

• As always, we recommend checking benefits and eligibility to determine the member’s benefits and any authorization requirements.
• All services must continue to meet medical necessity criteria.  We will only provide reimbursement for services that meet these requirements and for which a prior authorization has been obtained when required.

If you have any questions regarding this newsletter, please contact your BCBSKS provider consultant.