Beginning January 1, 2010, CVS Caremark (Caremark) will become the new pharmacy benefits manager (PBM) for Blue Cross & Blue Shield of Rhode Island (BCBSRI) health plans. Caremark will process prescription drug claims, provide mail order pharmacy services, conduct utilization review, and perform a variety of other activities.
Will there be changes?
- Members will receive a new BCBSRI member ID card.
- Even though the new ID card will list CVS Caremark as the PBM, members do not have to change pharmacies and are still free to visit any of the approximately 60,000 pharmacies in the network.
- The mail order pharmacy service will be operated by Caremark.
- The online pharmacy benefit information and services will look different.
- Any claims members file for direct reimbursement should be sent to Caremark.
- CVS Caremark will process pharmacy claims based on a member’s benefits.
What does CVS Caremark bring you and your members that’s an advantage over other PBM’s?
In addition to further developing the ongoing strategic partnership between BCBSRI and CVS Caremark, BCBSRI transitioned to CVS Caremark as its PBM because of their experience as an industry leader, their local presence, and their vision of improving healthcare. BCBSRI and CVS Caremark share a philosophy of promoting better health outcomes for our members through better access, coordinated care, and lower overall costs. More specifically, CVS Caremark provides proactive member communication (mail, phone, face-to-face), medication therapy counseling, adherence outreach, interactive decision support tools, physician connectivity, and ultimately, improved clinical outcomes. Our partnership with CVS Caremark aligns with BCBSRI's integrated health management strategy which is designed to improve the heath and healthcare of our members.
Which pharmacies are in the CVS Caremark network?
To meet our member’s needs at home or when traveling, CVS Caremark provides an open network of more than 60,000 pharmacies across the nation. This includes major chain stores as well as several local independently owned pharmacies that communities have supported for many years.
What about the members’ current prescriptions?
- Retail pharmacy: Our members’ pharmacies will still have their prescriptions on file. Members will need to show their new BCBSRI member ID cards the first time they get refills after January 1, 2010.
- Mail order pharmacy: Members’ prescriptions will be automatically transferred to Caremark. However, members’ payment information will not be transferred. When members need refills after January 1, 2010, they need to call Caremark at 1-866-329-3053 and update their patient profiles. Prescriptions that have expired, do not have refills remaining, or are for controlled substances (e.g., Valium, Tylenol with codeine, or Hydrocodone) will not be transferred to Caremark. Members must get new prescriptions from their physicians.
Will the transition to CVS Caremark have any impact to the formulary?
The transition to CVS Caremark will not impact the formulary. BCBSRI will continue to make changes in April and October of each year. For those members on drugs that are changing formulary status in April or October, they will receive a targeted mailing from CVS Caremark informing them of the changes, as they normally have in the past.
For a copy of the Pharmacy Update notification on this transition please click here.
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