BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics. The relationship between BCBSIL and contracting pharmacies is that of independent contractors. In addition, contracting pharmacies are contracted through Prime Therapeutics. This information applies to members and groups with prescription drug benefits administered through Blue Cross and Blue Shield of Illinois (BCBSIL).īCBSIL contracts with Prime Therapeutics to provide pharmacy benefit management and related other services. Group customers must contact their legal advisors if they have questions about proposed rules and new regulations, what they will require and how they will affect their benefit plans if finalized. While we provide information about federal guidance, we do not provide groups with legal or compliance advice. Our self-insured customers who have their pharmacy benefits carved-out will need to confirm how their carved-out PBM is managing COVID-19 diagnostic OTC testing. About 34.7 million people have received one or more doses, while more than 11.1. There is no option to opt-in or opt-out of diagnostic testing coverage According to the latest figures from CDC, 46.3 million COVID vaccine doses have been administered across the U.S.Covered under pharmacy benefit, not medical.We may have more vendors join in the future.)įor our self-insured customers who use BCBSIL and Prime Therapeutics to administer their pharmacy benefit, here's our approach: Direct-to-consumer shipping (allows member ability to order COVID-19 tests directly through a vendor partner, such as Walgreens and other major pharmacy chains.Member-submitted claims processing directly through Prime’s current process.Point-of-sale at more than 65,000 in-network pharmacies.Claims will be submitted directly from the pharmacy to BCBSIL. Members can use the same broad networks used for COVID-19 vaccines to request tests. What this means to you: BCBSIL will cover COVID-19 diagnostic OTC tests through our extensive network of participating pharmacies, for our fully insured members, and self-insured group members who have Prime Therapeutics ® coverage through BCBSIL. At-home testing for employment purposes is not considered a covered benefit under this federal guidance. Coverage is effective through the end of the federal public health emergency.Allows coverage of eight (8) tests per covered member, every 30 days (or, for example, 4 boxes with 2 tests per box).Without prior authorization or medical management techniques.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |