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Pharmacy Benefits & Coverage

Starting January 1, 2023, CVS Caremark, an independent company, will become the new pharmacy benefits manager to our nearly 1.9 million commercial, group Medex®', and Medicare Advantage members who have their pharmacy coverage with us.

With this change, you may start receiving communications from CVS Caremark related to drug recalls, drug savings opportunities for our members, and more.

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Member transition

Members can get information about the changes to their pharmacy benefits at bcbsma.info/pharmacyupdate. Commercial and Medex members will be notified throughout the month of November 2022. Medicare Advantage members will receive notification in November and December 2022.

 Commercial and Medex member letters. Includes a member letter guide that describes how members were identified to receive various messages.

 Medicare Advantage Mail Service Pharmacy letter. This letter is sent to members who will need to transition prescriptions to their new mail service pharmacy.

 Medicare Advantage formulary and network changes letter. This letter is sent to members experiencing a formulary change or who are using a pharmacy not in the network of pharmacies they’ll be able to use as of January 1, 2023.

 Medicare Advantage specialty medication letter. This letter is sent to members who will need to switch their medication to a specialty pharmacy.

Provider transition

We want to create a smooth transition for our provider partners and our members, so we are ensuring:




Active Mail Order Prescriptions Transfer Automatically Current Prior Authorization Approvals Transfer Automatically Retail Specialty Pharmacy Network Stays in Place
Transferring active mail order prescriptions automatically to the CVS Caremark Mail Service Pharmacy from the ESI Pharmacy. (Exceptions include controlled medications and prescriptions without any refills left). Ensuring current prior authorization approvals remain in effect until the date listed on the original approval decision. Keeping the same retail specialty pharmacy networks (for fertility specialty medications and all other medications on the formulary designated as specialty).

  What's the same?

  • Network of retail specialty pharmacies for medications designated as “specialty” on our formularies.
  • We will continue to review and process prior authorization requests when you use the following methods:
    • Submit eForms
    • Contact Pharmacy Operations 
    • Use electronic prior authorization tools (for example, covermymeds or Surescripts)


  What’s changing?

What’s new Prescriber action steps
Faxed notification reminders to prescribers before their patient’s prior authorization will expire. Applies to commercial members only. Renew the authorization for your patient if they need to continue on the medication.
Mail order pharmacy will now be CVS Caremark Mail Service Pharmacy. Look for CVS Caremark Mail Order in your EHR and send mail order prescriptions there. Update pre-populated or default pharmacies in your systems.
Programs and benefits to help members save on maintenance medications or medications used to treat chronic conditions. Refer to benefits and programs pages to learn more.
Formularies. Review the member’s formulary for coverage information.

We’re updating our formularies for January 1, 2023.

We’re also offering a new formulary for self-insured accounts called Standard Control with Advanced Control Specialty Formulary to replace the current National Preferred Formulary.

Pharmacies members use.

CVS Caremark has a broad network of more than 65,000 retail pharmacies nationwide, including large retail chains and neighborhood pharmacies.

Send prescriptions to in-network pharmacies when possible.
Member ID cards.

Members will receive new ID cards with updated Rx information.

Note: Look for an Rx symbol on the ID card, which indicates that the member has prescription coverage with us. If they don't have pharmacy coverage with us, ask if they have a separate card.

Update your records and remind patient to share new card with the pharmacy.

Commercial Medical ID Card

Medicare Medical ID Card

Learn more

Benefits

Programs

Rx Coverage

 September 30, 2022 News Alert on formulary, benefit and other changes for 2023

Questions?

For questions about how this affects you or your patients, contact your network representative or call Pharmacy Operations at 1-800-366-7778.


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.