Rx Frequently Asked Questions
We’re making improvements to our prescription drug plans that you’ll see starting Jan. 1, 2023. This will help us continue to provide access to medication you need through a large nationwide pharmacy network, while working to help make your prescriptions more affordable.
New mail order service
Optum Home Delivery1 will be your new mail order pharmacy, starting Jan.1, 2023, for Medicare individual and group members. You’ll no longer use Express Scripts®2 to fill your prescriptions for home delivery after this date.
Members using Walgreens Specialty Pharmacy for Mail Order medications will still be able to use as their mail order provider.
Yes, you always have the option to choose your pharmacy, however, you can save time and money by using the preferred mail order pharmacy.
Filling prescriptions
If you have existing Express Scripts home delivery prescriptions with valid refills, these will automatically transfer to Optum Home Delivery, the new home delivery, pharmacy.
You’ll receive letters in November and January with more details about the transition. Also, a representative from the Optum Home Delivery team will call you to discuss your prescription transfer in January.
- There are no refills remaining on your prescription.
- Your prescription has expired.
- Your medication is a controlled substance, which legally can’t be transferred. This includes some medications that are used to treat chronic pain, attention deficit hyperactivity disorder and seizure conditions. Ask your doctor or pharmacist if you’re unsure if you have this type of medication.
Before Jan. 1 — Prepare for the transition to Optum Home Delivery:
Have at least a one-month supply of your current maintenance medication available.
Controlled substances, expired prescriptions and prescriptions without refills cannot be transferred. If this applies to any of your medication, ask your doctor to write you a new prescription so it can be filled by the Optum Home Delivery pharmacy starting Jan. 1.
On or after Jan. 1 — Set up your Optum Home Delivery pharmacy account in one of the following ways:
Log in to your secured online member account or the BCBSM mobile app. Click on My Coverage, Prescription, then Order Online or Mail Order. You’ll need to provide a payment method.
Call the Optum Home Delivery pharmacy at 1-855-810-0007, 24/7 — available after Dec. 1, 2022. TTY users, call 711. Have your doctor submit an electronic prescription to Optum Home Delivery pharmacy.
Retail Pharmacy
Some pharmacies may no longer be in the Blue Cross Medicare and BCN Advantage network or their preferred status may change effective Jan. 1, 2023.
Some pharmacies will be considered out of network. Our pharmacy network manager will continue to work toward an agreement with other pharmacies. You’ll receive more information later this year if the pharmacies you use will change.
Starting Jan. 1, 2023, you can go to Pharmacies Medicare page and select Find a Pharmacy to find our list of pharmacies in our network.
If you continue to use an out-of-network pharmacy, you will have to pay for the full cost of your prescriptions. If you choose this option, you can request reimbursement from Blue Cross Medicare and BCN Advantage here.
However, Blue Cross Medicare and BCN Advantage will only reimburse for out-of-network claims in certain situations. If your claim is approved, Blue Cross and Blue Care Network will only reimburse you for the full retail price minus your applicable copay.
Communication updates
We’ll start sharing updates about the improvements in October. We’ll continue to use a combination of letters, email and other communications to tell members important details about new ID cards, our switch to the Optum Home Delivery pharmacy and improvements to the pharmacy pages in online member accounts. These updates will continue through Feb. 2023.
Drug lists
We typically make changes to our drug lists as part of our normal review process to study new medications coming to market, new drug indications, new generics and changes in reported safety concerns.
Blue Cross Blue Shield of Michigan and Blue Care Network Pharmacy and Therapeutics Committee of clinical experts evaluates our drug list options to provide access to the medication you need while helping to manage your costs. We’ll start mailing letters to affected members detailing these changes in October.
Member ID card
All members with Blue Cross or Blue Care Network Advantage Medicare pharmacy coverage will receive new ID cards. You’ll receive a new ID card in the mail between Nov. 15 and Dec. 31. Begin to use this new card starting Jan. 1 for your prescription medication to be covered correctly.
Do not use this card before January 1. You should continue to use your current member ID card at your pharmacy and your health care providers’ offices through Dec. 31. Always keep your Medicare ID card.
•The Rx BIN number on member ID cards is changing to 610011.
•The PCN is changing to CTRXMEDD.
•These numbers are required for pharmacy claims processing. This is a good way to tellyour new card apart from your old card
Yes, you can use your digital ID card at your pharmacy and health care providers’ offices, if you choose. You can also use your digital ID card to verify you have the correct physical ID card on hand. Your digital card will show the new information on Jan. 1, 2023.
Log in to your member account online or the BCBSM mobile app to find your digital ID card and more information about your plan.
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