Monthly Archives:September 2015

Bluechoice SC Specialty Pharmacy Update

22 Sep , 2015,
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Today, we received the following update from BlueChoice Health Plan of South Carolina. For 2015, BlueChoice SC is currently one of the only marketplace plans in South Carolina offering basic dental coverage for adults as a standard option on all marketplace plans!

New Specialty Pharmacy Vendor

Caremark Specialty Pharmacy will be our preferred specialty pharmacy vendor as ofJanuary 1, 2016. Caremark is an independent company that provides pharmacy benefits management on behalf of BlueChoice HealthPlan. Caremark also will perform prior authorizations for specialty drugs.

This transition will let us continue to provide top-quality pharmacy services to our members as we work to manage this crucial area of rising health care costs. Specialty drugs are used for complex or chronic conditions, such as cancer, rheumatoid arthritis, hepatitis C and multiple sclerosis. Besides being expensive, they may need special handling and careful clinical monitoring.

Benefits Won’t Change
We are reassuring members that their specialty pharmacy benefits will not change with this transition to a new vendor — unless the group is electing new or different coverage for 2016. We do update our specialty drug list as products and drug management programs change. The most current list is available on our website.

Why Caremark?
Caremark Specialty Pharmacy offers these main advantages:

  • Members’ overall experience should be more coordinated and seamless, since Caremark already is their pharmacy benefits manager.
  • As a new convenience, members will have the option of dropping off specialty prescriptions and picking up medications at any CVS store.
  • Specialty drug coverage is unique in that some medications we cover under the medical benefit rather than the pharmacy benefit. Caremark offers industry-leading capability to manage prescriptions covered under the medical benefit. This will help ensure that the right members get the right drugs at the right time — an important way to help groups control spending.

Who is Affected?
All members who have pharmacy coverage through one of our health plans are affected. Starting in January, they must use Caremark Specialty Pharmacy for all covered specialty drug prescriptions we cover under the pharmacy benefit.

Members will not have specialty drug coverage through any retail or other specialty pharmacy, including Accredo. Accredo is an independent company that currently provides specialty pharmacy services on behalf of BlueChoice HealthPlan.

Transition and Some Exceptions
Active specialty drug prescriptions with refills remaining will be transferred from Accredo to Caremark on January 1. All prior authorizations will remain in place. Please note these exceptions and special circumstances:

  • By law, prescriptions for compound drugs and controlled substances cannot be transferred. We will notify members with these prescriptions that they need to get new prescriptions and Caremark can assist them.
  • A few specialty drugs are only available at a specialty pharmacy other than Caremark. We will notify members using these drugs that they will continue to have coverage using another specialty pharmacy.
  • The ability to drop off and pick up specialty drugs at a CVS retail store has a few limitations. It does not include certain products, such as growth hormone and infertility drugs. Also, this service is not available in Arkansas, Oklahoma and West Virginia.

BCBS-SC Medical Loss Ratio update

17 Sep , 2015,
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Today, we received the update below from Blue Cross Blue Shield of South Carolina regarding Medical Loss Ratio Rebates for members with Individual health insurance policies:

BCBS-SC Medical Loss Ratio (MLR) Rebates

Under the Patient Protection and Affordable Care Act (PPACA), BlueCross BlueShield of South Carolina is required to report our MLR to state and federal agencies annually. If we do not meet certain targets, we must issue rebates to individual members.

BlueCross will issue MLR rebates to members who had individual policies with us any time in 2014. This includes individuals who purchased qualified health plans under the PPACA from the federal Exchange or directly from us. It also includes individuals who have non-PPACA (grandfathered and non-grandfathered) plans.

BlueCross Blueshield of SC will mail rebate checks and letters to members on September 18.

Get additional information about the rebates.