We’re transitioning to new pharmacy benefit manager

Blue Cross Blue Shield of Michigan and Blue Care Network’s transition to a new pharmacy benefit manager, which we reported in a March Record article, will result in certain changes we want to alert you to.

As you may have read, we’re moving from Express Scripts, Inc. to OptumRx on Jan. 1, 2022, for commercial and individual group members, and Jan. 1, 2023, for Medicare Advantage individual and group members. The change is expected to improve the pharmacy experience for members and customers, better manage drug costs and drive better health outcomes.

While we anticipate that the bulk of the transition will be seamless for our members and health care providers, members who use home delivery pharmacy services may be affected. Most of these members’ current prescriptions with Express Scripts will automatically transfer to OptumRx if they have refills remaining, but prescriptions for controlled substances won’t transfer automatically.

Members with a prescription for a controlled substance will need to see their doctor to request a new prescription for our new home delivery pharmacy. Examples include medications for ADHD and seizures, as well as opioid pain medications like oxycodone, methadone and other drugs that put a person at high risk for developing substance use disorder.

We’re sending letters to members in mid-September to explain what they need to do. A second letter from OptumRx will follow in November.

After receiving these letters, some members may schedule appointments with their health care providers, including primary care providers and specialists, to request new prescriptions for medications they want delivered to their homes.

New ID cards

Due to the transition to OptumRx, we’ll mail about 1.8 million new ID cards to members this fall, beginning Oct. 3. Members must show their new cards at the pharmacy starting Jan. 1 for their prescriptions to be covered correctly under their benefits.

Electronic tools for providers

We’ll provide more information in The Record later this year about electronic tools for prior authorization requests and member benefits information related to this transition.