Medicare Advantage plans transitioning to Optum Rx pharmacy benefit manager

We notified providers earlier this year that the pharmacy benefit manager for our Medicare Advantage individual and group members would transition from Express Scripts, Inc. to Optum Rx^® beginning on Jan. 1, 2023. This applies to all our Medicare members with pharmacy coverage, including Medicare Plus Blue℠ and BCN Advantage℠ members. Our commercial plans transitioned on Jan. 1, 2022, as detailed in this January 2022 article in The Record.

As we indicated previously, the transition should be seamless for our participating health care providers and pharmacists. However, the major change is that Optum Home Delivery will provide mail-order drugs for preferred cost sharing, starting Jan. 1, 2023. You can expect that patients using our current mail-order pharmacy will be asking for new prescriptions for controlled substances, expired prescriptions or prescriptions without refills so they can be filled by Optum Home Delivery.

We’ll mail new ID cards to our members with Medicare Advantage prescription drug plans. They must show their new cards at the pharmacy starting Jan. 1, 2023, to help ensure that their prescriptions are covered correctly under their benefits.

You should continue to submit electronic prior authorizations for Medicare Plus Blue and BCN Advantage members using your current electronic medical record system or CoverMyMeds^® through Availity. Keep in mind that the BIN number changes to 610011, effective Jan. 1, 2023, for all Medicare Plus Blue and BCN Advantage members.

Availity is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal services.