August 11, 2021
A Change in 90-Day Supply Coverage to Apply for Some 2022 Pharmacy Networks
What’s Changing: Starting Jan. 1, 2022, and upon renewal, some Custom Fully Insured and Administrative Services Only (ASO) Large Group and/or National Accounts will only have 90-day supply retail coverage available at an Extended Supply Network (ESN) pharmacy.
This change applies to:
- Custom Fully Insured or custom ASO clients selecting a 90-day retail benefit on the Advantage pharmacy network
- Custom ASO clients selecting a 90-day retail benefit on the Traditional Select pharmacy network
With an ESN, members enjoy the convenience of getting up to 90-day supplies of eligible medications at a local in-network pharmacy. Most of these are maintenance (or long-term) medications used to treat a chronic or ongoing condition. Employer group customers may also see cost savings as a result of increased adherence.
What else?
- On or after Jan. 1, 2022, members will only be able to fill a 90-day supply of covered long-term medications at retail pharmacies that are part of the ESN.
- They will also be able to fill short-term 30-day supply prescriptions at these pharmacies, or any other in-network pharmacy.
- This change may impact members who were filling 90-day supplies at retail pharmacies not included in the ESN. Based on claims history, notification letters may be sent to these members before the effective date.
Are there any exceptions? This change does not impact groups on the Advantage or Traditional Select pharmacy networks without selected 90-day retail benefits. Groups on any other pharmacy network are also not impacted by this change as 90-day retail benefits are automatically in place.
Questions? If you have any questions, reach out to your Blue Cross and Blue Shield of Illinois representative.
This information applies to members and groups with prescription drug benefits administered through Blue Cross and Blue Shield of Illinois (BCBSIL).
Prime Therapeutics LLC is a separate pharmacy benefit management company contracted by BCBSIL to provide pharmacy benefit management and related other services. In addition, contracting pharmacies are contracted through Prime Therapeutics. The relationship between BCBSIL and contracting pharmacies is that of independent contractors. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.
