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March 2017

Members can get medications synchronized through Express Scripts, starting March 15

Blue Cross Blue Shield of Michigan and Blue Care Network will launch their medication synchronization program with Express Scripts for all commercial (non-Medicare) lines of business, starting March 15, 2017.

This program will allow medications for a patient to be refilled on the same day. Not only does the member get the convenience of fewer trips to the pharmacy, but the program may also increase medication adherence.

We’re adding this program in response to Michigan Public Act 38 of 2016, which requires that insurers allow members to synchronize multiple maintenance drug prescriptions for chronic long-term care conditions. The medication synchronization legislation takes effect March 15, 2017.

Which drug claims apply to the medication synchronization program?
The program allows:

  • Medication synchronization of maintenance drugs for chronic long-term care conditions, with the exception of:
    • Most Schedule 2-5 controlled substances (anti-epileptic prescriptions allowed)
    • Select prescription drugs that are limited to certain fill requirements
  • Medication synchronization on prescriptions that have authorized refills remaining

How will we synchronize prescription drugs?

  • When a participating pharmacy submits a claim for a member that meets the criteria, our claims processer (Express Scripts) will apply a prorated, daily cost-sharing rate to the maintenance prescription drugs. The claims processing system will allow a pharmacist to dispense up to 29 days of acceptable drugs.
  • Participating pharmacies will collect from the member the applicable cost share and receive a dispensing fee for each synchronized prescription claim submitted.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2016 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.