2020 Pharmacy FAQs
What is happening to my prescription drug coverage on Jan. 1, 2020?
Beginning Jan. 1, 2020, the pharmacy benefit for BlueCross BlueShield of South Carolina will be administered by a new pharmacy benefits manager (PBM). The new PBM, OptumRx, is an independent company that has been contracted to provide certain services related to your health plan’s prescription drug coverage.
How will this change affect me?
There will be little or no effect for most members. You will, however, be sent a new ID card to use in 2020. Some members may experience additional changes to their prescription drug coverage on Jan. 1, as part of their health plan’s regular pharmacy benefit updates.
How will I know if a drug coverage change affects me?
If you are currently taking a drug that will be affected by any coverage or program changes taking effect on Jan. 1, we will mail you a letter in early November describing the change and any actions needed.
Will I receive a new ID card?
All members will be sent a new ID card in late November or early December to replace their current one. As before, the new ID card is to be used for both medical and pharmacy benefits. Members should be sure to show the new card at the pharmacy when they have their first prescription filled in 2020. Members can also get an electronic version of their ID card by logging in to the secured portion of this website.
Will the drugs covered by my plan change?
For most members, the drugs covered by their plan will not change beyond the minor updates that take place routinely at the beginning of each year. If your coverage is through an employer group that will be using a new covered drug list (or formulary) effective Jan. 1., you will receive more information about these changes and what they may mean for you. We will send you a letter in November with more details.
Will I have to change the pharmacy I use to fill my prescriptions?
Our current pharmacy network includes almost all the same pharmacies as our new 2020 pharmacy network. There are almost 70,000 pharmacies, including all major chain pharmacies and most independent pharmacies. If, for some reason, a pharmacy you are using will not be part of the new network, we will send you a letter in December to inform you and suggest other network pharmacies that are nearby.
Beginning October 15, you can use the “Find a Pharmacy” locator to search for 2020 network pharmacies. Always make sure to check your plan materials for information about specific network information that may apply to your plan.
Will CVS pharmacies still be part of the network?
CVS pharmacies are included in our new national pharmacy network.
Will the price I pay for prescription drugs change?
Your pharmacy benefit is based on tiers. Tiers are the different cost levels you pay for medications. For most members, the drugs you take will stay at their current tier. However, from time to time, some drugs may move to a higher tier. If a drug you’re taking will be moving to a higher tier on Jan. 1, we will send you a letter to let you know.
What is a specialty drug?
Specialty prescription drugs treat complex or chronic medical conditions. They may require patient-specific dosing and careful clinical monitoring.
I take a specialty drug. Will there be a new specialty pharmacy?
Yes. We will have a new specialty pharmacy, Optum Specialty Pharmacy, which is a division of the new PBM. If your specialty prescription is now being filled by CVS Specialty Pharmacy*—and you have refills remaining—your prescription will be transferred to Optum Specialty Pharmacy.
Do I need to take any action regarding my specialty prescriptions?
Existing prescriptions will be transferred from CVS Specialty to Optum Specialty Pharmacy around Jan. 1, 2020. Current members can call 877-259-9428 to get set up to use Optum Specialty Pharmacy beginning Dec. 2, 2019. Before this date, you will not have a profile in the Optum Specialty Pharmacy system, and no information can be documented.
I use mail service to receive some prescription drugs. Will anything change for me?
Members who use mail service receive up to a 90-day supply of medications they take regularly. Beginning Jan. 1, 2020, mail service will be provided by OptumRx Home Delivery. Open prescription refills will be transferred from CVS Mail Service* to the new home delivery pharmacy around Jan. 1, 2020.
What will happen to existing mail-order scripts?
Open prescription refills will be transferred from CVS Mail Service to OptumRx Home Delivery pharmacy. Some scripts will not transfer (compounds, controlled substances and prescriptions with no refills left). We will inform you if you need a new prescription(s) to continue filling via mail.
Do I need to take any action regarding my mail-service prescriptions?
Although most prescriptions will be transferred, you will need to set up a profile with the new mail-service pharmacy. You can call 855-811-2218 to get set up beginning Dec. 2, 2019. Before this date, you will not have a profile in the system, and no information can be documented. After Jan. 1, you can call or use the web to set up your profile.
What if I need a new prescription for mail service?
Your doctor can e-prescribe directly to OptumRx Home Delivery pharmacy, or you can submit a copy of the prescription with a mail service form.
A drug I take required prior authorization. Will anything change for me?
All active prior authorizations (PAs) will be transferred around Jan. 1 and remain active.