Blue Review
A newsletter for contracting institutional and professional providers

January 2020

New Formulary Notification for Blue Cross Community Health PlansSM (BCCHPSM): Uniform Preferred Drug List

The update is to notify Blue Cross and Blue Shield of Illinois (BCBSIL) independently contracted providers about a change to the BCBSIL formulary effective Jan. 1, 2020.

Illinois Healthcare and Family Services (HFS) has mandated that effective Jan. 1, 2020, all Illinois Managed Care Organizations (MCO) adopt the HFS Preferred Drug List (PDL). Members that are currently taking medications that are not on the HFS PDL or that now require a prior authorization have been notified of this change and will be allowed a grandfather period of at least 90 days to transition to a preferred drug or request a prior authorization.

You may download the PDL or visit MyPrime.

To prevent member disruption, we suggest you access the BCBSIL formulary at the link above on or after Jan. 1, 2020, to determine if your patients will need to change medications to a preferred agent. You may also submit a prior authorization request to allow them to continue therapy with their current medications by faxing 877-480-8130 or calling 866-202-3474 (TTY/TDD 711).

To submit electronically, visit MyPrime and access the Coverage Exception Form. You can also visit CoverMyMeds®.

If you have any questions regarding processing claims, please call the Prime Contact Center at 800-821-4795.

CoverMyMeds is a registered trademark of CoverMyMeds LLC, an independent third party vendor that is solely responsible for its products and services. BCBSIL makes no endorsement, representations or warranties regarding any products or services offered by independent third party vendors. If you have any questions regarding the products or services they offer, you should contact the vendor(s) directly.

BCBSIL contracts with Prime Therapeutics (Prime) to provide pharmacy benefit management and other related services. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. MyPrime.com is an online resource offered by Prime.