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New pharmacy benefits for our members—coming in 2023
December 9, 2022

This article is for all providers caring for our members

As a reminder, our members’ pharmacy benefits are changing as of January 1, 2023. Commercial1 and Medicare Advantage members will have a new pharmacy benefit manager, CVS Caremark2, to administer their pharmacy benefits and services, including offering a new network of pharmacies for filling prescriptions.

Their network has more than 65,000 pharmacies nationwide—including CVS Pharmacy and many others, such as large retail chains and other neighborhood pharmacies. Members will also use CVS Caremark Mail Service Pharmacy for their maintenance medications.

This transition will have little or no impact to our members and prescribers.

  • Active mail order prescriptions transfer automatically
  • Prior authorization approvals transfer automatically
  • There will be minimal changes to the network of pharmacies members can use
  • Specialty pharmacy network stays the same
  • Formularies (covered lists of medications) have minimal changes

Members who are affected by this change should have already received communications. They can be found here. We suggested that they share this information with their prescribers.

How you can help support our members during this transition and beyond

Prescriber’s Checklist

Write new mail order prescriptions and send to the CVS Caremark Mail Service Pharmacy for the following instances only: Controlled medications and prescriptions without refills. All other active mail order prescriptions will transfer from the Express Scripts, Inc. (ESI) Pharmacy to CVS Caremark Mail Service Pharmacy.

Remind your patients that they need to set up an account for CVS Caremark Mail Service Pharmacy and request their next refill to ensure their prescriptions mail.

Here’s how your patients can do this after January 1, 2023:

  • Sign into bluecrossma.org to access the mail service pharmacy website and enroll; or
  • Call 1-877-817-0477, TTY:711 (for commercial members) or 1-877-817-0493, TTY: 711 (for Medicare members).

Remember to confirm what pharmacy the member would like their medication sent. ESI Mail Order will no longer be able to fill prescriptions for our members after January 1, 2023.

Renew the authorization for your patient (if medication still needed) once you receive a faxed notification from us, reminding you that your patient’s prior authorization is expiring. (After January 1, 2023 and for Commercial members only.)

Remind your patients to share their new ID card, updated with Rx information, with the pharmacy. You’ll know your patient has pharmacy coverage with Blue Cross by looking at their ID card. Please see below.

Commercial Medical ID Card

Medicare Medical ID Card

We’ve valued our partnership with ESI and they will continue to serve as the pharmacy benefit administrator through the end of 2022. 

Learn more

For more information about this transition go to bluecrossma.com/provider and click on 2023 Pharmacy Benefit Manager Transition.

There, you’ll find:

  • Affected member letter templates
  • Links to 2023 formularies on the Rx coverage page
  • September 30, 2022 News Alert on formulary, benefit, and other changes for 2023
  • Information on benefits and programs, and more

  1. Includes commercial members who have pharmacy coverage with us and Group Medex ®' members with a 3-tier pharmacy benefit.
  2. CaremarkPCS Health, LLC (“CVS Caremark”) is an independent company that has been contracted to administer pharmacy benefits and provide certain pharmacy services for Blue Cross Blue Shield of Massachusetts. CVS Caremark is part of the CVS Health family of companies. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association.

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