May 27, 2021
Blue Cross and Blue Shield of New Mexico (BCBSNM) has chosen new mail order and specialty pharmacy service providers through our pharmacy benefit manager (PBM), Prime Therapeutics LLC (Prime).
As of May 1, 2021, BCBSNM members, whose pharmacy benefits are administrated through Prime, now have Express Scripts® Pharmacy for mail order services and Accredo® (a full-service specialty pharmacy) for related services. Based on the member's benefit plan, other in-network pharmacies may be available.
These vendor changes apply for Blue Cross Community CentennialSM, commercial group and retail plan members. Please note: BCBSNM Medicare Part D subscribers will have these added choices starting August 1, 2021. These subscribers may ask you to move their prescription(s) to one of these new pharmacy services at that time.
A summary of the new pharmacy services offered and some related actions you as the prescribing provider may need to take are described below.
Mail Order Services
Some of your patients will have a new mail order pharmacy, Express Scripts® Pharmacy, and/or a new choice to fill covered 90-day supply maintenance medicines. Mail order service provides a convenient way for your patients to get up to a 90-day supply of a maintenance (or long-term) medicine by mail.
- There is no urgent action you need to take. If your patients have existing mail order prescriptions, the prescriptions may have been sent to Express Scripts® Pharmacy on May 1, 2021. Some prescriptions that are not eligible for transfer to Express Scripts® Pharmacy are those for controlled substances and medicines regulated by a REMS (Risk Evaluation and Mitigation Strategy) program, or those that are expired or have no refills left as of May 1, 2021.
- After May 1, 2021, some of your patients may ask you to send a new prescription to Express Scripts® Pharmacy. These patients may be new to mail order or did not have prescriptions that moved to Express Scripts® Pharmacy but wish to keep using a mail order service.
- When renewing your patients' current maintenance prescriptions or when writing new prescriptions for mail order, send them to Express Scripts® Pharmacy:
- Electronically – Use your EMR system to e-prescribe to: Express Scripts Home Delivery. For questions on e-prescribing, call 1-800-211-1456, option 5.
- By Fax – Call 888-327-9791 for faxing instructions. (Faxes can only be received from a doctor's office.)
- By Phone – Call the pharmacy at 833-715-0942 for commercial group and retail plan members or 833-599-0509 for Centennial plan members.
- About Express Scripts® Pharmacy:
- With a thorough validation process, the pharmacy has a 99.99% dispensing accuracy and more than 30 years of prescription home delivery experience.
- Pharmacists leverage their clinical knowledge and experiences to review for possible drug therapy issues and address adherence gaps.
- There are many locations across the US, allowing for fast processing and dispensing with no added cost for standard delivery.
- Support staff are on hand 24 hours a day, 7 days a week to help with any medicine questions or concerns.
- Members can use digital tools to refill prescriptions, track orders, set reminders to take medicine(s) and more.
- For more information on Express Scripts® Pharmacy, visit express-scripts.com/rx.
Specialty Pharmacy Services
Some of your patients will have Accredo as a new choice to get specialty drugs covered under the pharmacy benefit. Accredo provides patients with access to specialty drugs, as well as personalized care and dedicated clinical resources to help them manage their health condition(s).
BCBSNM members should use an in-network specialty pharmacy to take full advantage of their pharmacy benefit coverage. Based on a member's benefit plan, there may be other in-network options. Please note: Specialty pharmacies that supply specialty drugs covered under the member's medical benefit are not affected by these changes and can still be used.
- There is no urgent action you need to take. If your patients have existing pharmacy benefit specialty drug prescriptions, the prescriptions may have been sent to Accredo on May 1. Some prescriptions that are not eligible for transfer are controlled substances, expired prescriptions or prescriptions with no refills left as of May 1, 2021.
- After May 1, 2021 some of your patients may ask you to send a new prescription to Accredo. These patients may be new to specialty drug treatments or did not have prescriptions that moved to Accredo but wish to keep using an in-network specialty pharmacy.
- When renewing your patients' current specialty drug prescriptions or when writing new prescriptions, you can send them to Accredo. To get started, visit accredo.com/prescribers for referral forms by therapy, e-prescribe to Accredo1 or call the pharmacy at 833-721-1619 for commercial group and retail plan members as well as Blue Cross Community Centennial plan members.
- About Accredo:
- You and your patients have access to a team of 500 condition-specific pharmacists and more than 600 nurses with extensive training and experience.
- Staff support one of 15 Therapeutic Resource Centers® (TRCs), each focused on a specific specialty condition, and are on hand 24 hours a day, 7 days a week to help answer questions.
- Through one-on-one counseling, personal support and routine contact, your patients are encouraged to stick to their treatment regimens for the best results. Accredo may reach out to you at times to coordinate care.2
- The pharmacy has broad access to specialty drugs, including many with limited distribution, with no added cost for standard delivery.
- Accredo aims to provide a simple member experience, through a member's preferred means of communication (phone call, email, texting, mobile app and/or online member website).
- Providers have varied support tools, such as physician concierge, e-prescribe, ePA and interoperability with EHRs.
- You have visibility to the status for all of your Accredo patients through Accredo's prescriber portal at https://myAccredoPatients.com , where you can:
- See patient referrals, refills and renewals
- Flag patients or prescriptions for follow-up
- Check on prior authorizations
- Track prescriptions as they're processed and filled
- For more information about Accredo, visit accredo.com/prescribers.
1 eRx to NCPDP ID 4436920, 1640 Century Center Parkway, Memphis, TN 38134
2 Treatment decisions are between you and your patient.
Please take this opportunity to update any pharmacy information that may be stored in your patients' records. Also, if your patient had a current benefit prior authorization approval on file, it will follow the standard BCBSNM process for renewals.
Members can call us at the number listed on their BCBSNM Member ID card if they have any questions. They can also log in to their Blue Access for MembersSM (BAMSM) account on bcbsnm.com for online resources. If you have any questions, need further help or need to check a patient's coverage, please call us at the number on your patient's ID card.
Express Scripts® Pharmacy is a pharmacy that is contracted to provide mail pharmacy services to members of Blue Cross and Blue Shield of New Mexico (BCBSNM). The relationship between Express Scripts® Pharmacy and BCBSNM is that of independent contractors. Express Scripts® Pharmacy is a trademark of Express Scripts Strategic Development, Inc.
Accredo is a specialty pharmacy that is contracted to provide services to members of Blue Cross and Blue Shield of New Mexico (BCBSNM). The relationship between Accredo and BCBSNM is that of independent contractors. Accredo is a trademark of Express Scripts Strategic Development, Inc.
Prime Therapeutics LLC is a separate pharmacy benefit management company contracted by BCBSNM to provide pharmacy benefit management and related other services. BCBSNM, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.
Such services for Blue Cross Community CentennialSM members are funded in part with the State of New Mexico.
Blue Cross®, Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.
Pharmacy benefits and limits are subject to the terms set forth in the member's certificate of coverage which may vary from the limits set forth above. For more complete details, including benefits, limitations and exclusions, members should refer to their certificate of coverage. Regardless of benefits, the final decision about any medication and pharmacy choice is between the member and their health care provider.