This network change impacts fully insured group and retail market (Metallic plan small group and individual) members. It does not impact Medicaid or Medicare plans at this time.
ASO groups have the choice to either adopt this revised pharmacy network with CVS excluded or remain with the current pharmacy network that includes CVS. Contact your BCBSTX representative for more information.
Working closely with Prime Therapeutics, BCBSTX continuously assesses our pharmacy networks and offerings to ensure we are maintaining affordable benefits for our members, including obtaining competitive reimbursement rates from participating pharmacies within Prime’s network. Through ongoing negotiations, CVS Pharmacy® requested a higher reimbursement rate for generic prescriptions as compared to other pharmacies. Therefore, BCBSTX has made the decision to no longer include CVS pharmacies within the pharmacy network.
Members will continue to have access to more than 55,000 nationwide pharmacies in network (without CVS), with more than 4,000 located within Texas. This includes many major pharmacy chains such as Walgreens, Walmart, Kroger, HEB, Brookshire’s and many independent pharmacies. In every county where we have a presence, we exceed network adequacy standards set by Texas with the remaining pharmacies in network.
Additionally, BCBSTX offers retail market members affordable options through our 2016 Preferred Pharmacy Network, including as low as $0 copays. This network includes more than 2,000 pharmacies, with at least one major national chain, a grocery chain and many independent pharmacies.
BCBSTX is committed to helping our members find the most convenient alternative for their pharmacy coverage needs. Impacted members, who have had recent CVS claims, will be notified in October with a letter. This letter will provide information on how to find an alternative network pharmacy, as well as how to transfer any current refill/new prescriptions to their new pharmacy.