Specialty Pharmacy Changes for 2020: Individual Plans

  • Pharmacy News
    Published November 11, 2019

    For producers who sell Premera individual plans

    Premera Blue Cross regularly reviews its pharmacy programs for effectiveness and value—including evaluating ways to improve the member experience. To bring better value to our customers and connect them sooner to the programs offered by our preferred specialty pharmacies, Premera is changing the specialty pharmacy benefit for individual plans for 2020.

    Please refer to the following FAQ for information about changes to specialty pharmacy.

    Question Answer
    What is changing? Starting January 1, 2020, all Premera individual members will have a mandatory specialty pharmacy benefit with an exclusive specialty pharmacy network.
    How does this impact members?

    Premera individual members will need to fill select specialty pharmacy prescriptions at the Premera preferred specialty pharmacy, Accredo.

    They cannot fill these specialty pharmacy prescriptions at a retail pharmacy.

    Which specialty drugs does this change apply to? This change applies to specialty drugs found on the Mandatory Specialty Drug List
    How will members be notified of this change? Impacted members will be informed of this change in their annual notice.

    Action to take

    Familiarize yourself with this change to the mandatory specialty benefit for 2020. If your clients have questions, please have them call Premera customer service.

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