Who is the PBM for BCBS of NC?

Prime Therapeutics
Blue Cross NC began its partnership with Prime Therapeutics (Prime) for pharmacy benefits management on April 1, 2012.

Is Express Scripts the same as Prime Therapeutics?

In late 2019, Prime announced a major restructuring of its business via a novel partnership with Express Scripts. The news about this new Prime Therapeutics/Express Scripts relationship was first announced during last week’s Nephron Research Pharmacy Benefit Management Innovation Symposium.

How do I contact Prime Therapeutics?

Member services. 855.457.0007. TTY users call 711. 24 hours a day, 7 days a week.
24-hour health care provider contact centers. Plan specific phone numbers.
Corporate. 800.858.0723.
Fraud tip hotline. 800.731.3269.

Is Walgreens in network for CVS Caremark?

Walgreens pharmacies will continue to participate in the CVS Caremark national networks, so plan members will not need to transfer their prescriptions to other network pharmacies.

Does Walmart take Florida Blue?

In 2017, will I have coverage at pharmacies other than Walgreens? Yes, if you have a BlueOptions, BlueCare or BlueSelect health plan, you can choose from many other in-network pharmacies, including Publix, Winn-Dixie, Walmart, and other smaller retailers and independent pharmacies.

How do I request prior review and certification from Blue Cross?

Your health care provider can use any of the following ways to request prior review and certification: By phone: Blue Cross NC Utilization Management at 1-800-672-7897 Monday to Friday, 8 a.m. — 5 p.m. ET By fax: Request form

What is a prior authorization form?

Prior Authorization. Required on some medications before your drug will be covered. If your health plan’s formulary guide indicates that you need a Prior Authorization for a specific drug, your physician must submit a prior authorization request form to the health plan for approval.

How do I request coverage for a patient’s prescription?

If you wish to request coverage for a patient’s prescription which hasn’t been listed on their health insurance provider’s formulary, you will need to fill out a Prime Therapeutics Prior Authorization Form (a.k.a. Formulary Exception Form).

What procedures require prior review and certification for my plan?

Always check your Benefit Booklet for specific information about your plan. The following procedures typically require prior review and certification:, Inpatient admissions (with the exception of maternity admissions) — elective, planned in advance or not related to an emergency.