These pharmacy programs are available for members.
These pharmacy programs are available for members.
The prior authorization/step therapy program is designed to encourage safe, cost-effective medication use. This program may be part of your prescription drug benefit plan. To find out if your specific benefit plan includes the prior authorization/step therapy program, and which drugs are part of your plan, refer to your benefit materials.
Under this program, your doctor will be required to request pre-approval, or prior authorization, through Blue Cross and Blue Shield of New Mexico (BCBSNM) in order to get benefits for the select drugs.
The step therapy program requires that you have prescription history for a "first-line" medication before your benefit plan will cover a "second-line" drug.
Step 1: If possible, your doctor should prescribe a first-line medication right for your condition.
Step 2: If you and your doctor decide that a first-line drug is not right for you or is not as good in treating your condition, your doctor should submit a step therapy exception request for coverage of the other drug. Your doctor can find request forms at bcbsnm.com/provider.
If you have questions about the prior authorization/step therapy program, call the number listed on your BCBSNM ID card.
Specialty medications are those used to treat serious or chronic conditions. Examples include hepatitis C, hemophilia, cancer, multiple sclerosis and rheumatoid arthritis. They often call for carefully following a treatment plan (or taking on a strict schedule), have special handling or storage needs, and may only be stocked by select pharmacies. More information is available in the specialty pharmacy program member flier.
Download the Specialty Pharmacy Program Drug List, which includes a reminder about coverage for self-administered specialty medications.
A split fill program may apply to some medications like select oral oncology (cancer), multiple sclerosis and iron toxicity drugs. This program lets you try the medication first to make sure you can tolerate any potential side effects. You will get a partial fill of your prescription and only pay for what was filled (a prorated cost of your benefits).
Coverage benefits and requirements may vary based on your plan benefits. Call the number listed on your BCBSNM member ID card if you have any questions.
To order through Accredo:
A patient care advocate will work with you and your doctor to confirm your order, mailing address and arrange delivery of your covered medications.
When you purchase specialty drugs through Accredo, you can have your self-administered specialty medications delivered directly to you, or to your doctor's office. You also receive at no additional charge:
BCBSNM members who use oral oncology or hemophilia specialty drugs may have other in-network specialty pharmacy options. Log in to your Blue Access for MembersSM account to find a preferred specialty pharmacy near you.
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 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 LLC.
Express Scripts® Pharmacy, the mail order pharmacy for members with BCBSNM prescription drug coverage, provides safe, fast and cost-effective pharmacy services that can save you time and money. With this program, you can obtain up to a 90-day supply of long-term (or maintenance) medications through Express Scripts® Pharmacy. Maintenance medications are those drugs you may take on an ongoing basis to treat conditions such as high cholesterol, high blood pressure or diabetes. Download the maintenance drug list to check if your medication is included.
You have more than one option to fill or refill a prescription online or from a mobile device:
Call 1-833-715-0942, 24/7, to refill, transfer a current prescription or get started with home delivery. Please have your member ID card, prescription information and your doctor’s contact information available.
To send a prescription order through the mail, log in to Blue Access for MembersSM. Complete the mail order form. Mail your prescription, completed order form and payment to Express Scripts® Pharmacy.
For more information about using mail order, you can download the Express Scripts® Pharmacy flier.
If you have coverage through Blue Cross and Blue Shield of New Mexico, vaccinations may be covered under the medical benefit or the prescription drug benefit, based on your plan. Select vaccines can be conveniently administered at a pharmacy near you. These vaccines can help protect you from illnesses such as the flu, pneumonia, shingles, hepatitis B, meningitis, HPV, tetanus, diphtheria and pertussis.
To learn more about which vaccines are available under your plan for you and your covered family members, check your benefit materials for details and any necessary copays. Or, you can call the phone number listed on your member ID card.
More information is available in the pharmacy vaccine program member flier.
If you have BCBSNM prescription drug benefit coverage, you have access to our team of clinical pharmacists and other resource tools to help answer questions you may have about your prescriptions.
The Pharmaceutical Care Management (PCM) program helps you get the best results from the medicines you take. A member of the PCM team may reach out to talk with you about the medicines you take. The medication review by a clinical pharmacist helps make sure the medicines you are taking are safe and work well. The pharmacist can also share ways to help you lower your out-of-pocket costs for your prescriptions.
For more information about how PCM works:
Last Updated: March 13, 2023