Reminder: Our transition to OptumRx

Blue Cross Blue Shield of Michigan and Blue Care Network are transitioning to a new pharmacy benefit manager, moving from Express Scripts, Inc. to OptumRx. This change will take place on Jan. 1, 2022, for commercial individual and group members, and Jan. 1, 2023, for Medicare Advantage individual and group members.

We anticipate the bulk of the transition will be seamless for our members and health care providers. However, members using our current home delivery pharmacy to fill a prescription for a controlled substance — or those with expired prescriptions or prescriptions without refills — should ask their doctor to write a new prescription so it can be filled by OptumRx home delivery pharmacy, starting Jan. 1.

As part of the transition, we’ve mailed about 1.8 million new ID cards to members. Members must show their new cards at the pharmacy starting Jan. 1 to help ensure their prescriptions are covered correctly under their benefits.

We’ve also made some enhancements to our provider-facing tools to assist with prescribing and submitting prior authorizations electronically.

These enhancements will primarily take place behind the scenes and won’t have a major effect on how providers prescribe and submit prior authorizations or check on patients’ benefits.

Continue to use your current electronic medical record system or CoverMyMeds^® to submit electronic prior authorizations for Blue Cross and BCN members. Keep in mind that the BIN number changes to 610011, effective Jan. 1, 2022, for all Blue Cross and BCN commercial members.

Need more information?

• For more information on ePA and CoverMyMeds, see our ePA flyer.
• For more information on the transition to OptumRx, see the September issue of The Record and the November-December issue of Hospital and Physician Update.