Capital BlueCross: New Specialty Drug Provider Reminder

New Specialty Drug Provider Reminders

Effective January 1, 2018, AllianceRx Walgreen Prime became Capital BlueCross’s preferred specialty medication vendor for commercial Large Group business. In addition, they are also the exclusive specialty vendor for their Individual product and Small Group business.

  • Transitioning to AllianceRx Walgreens Prime will be mandatory for customers whose prescription drug benefit includes a closed/exclusive specialty network access arrangement (this includes Capital’s individual product and Small Group business).
  • Transitioning to AllianceRx Walgreens Prime will be mandatory only when filling a specialty medication that is designated as exclusive for customers whose prescription drug benefit includes an open/closed specialty network access arrangement. (Under this arrangement, specialty medications that are designated as non-exclusive can also be filled at participating retail pharmacies).
  • Transitioning to AllianceRx Walgreens Prime will be optional for customers whose prescription drug benefit includes an open specialty network access arrangement.

Also, AllianceRx Walgreens Prime will replace ACRO Pharmaceuticals as Capital’s pharmacy of choice to fill the medications that are covered under a customer’s medical plan and administered in a doctor’s office or facility.

Customer Transition Information

Customers must be enrolled with AllianceRx Walgreens Prime before filling their first medication to avoid disruption.

AllianceRx Walgreens Prime will not ship medications until the customer has enrolled. This customer action is critical.

Capital BlueCross provided a contact file of current specialty pharmacy patients and their prescriptions to AllianceRx Walgreens Prime, and also sent introductory letters to customers. AllianceRx Walgreens Prime made outbound calls to customers, encouraging enrollment, and will send a welcome packet with the first prescription fill. The packet will include clinical education materials, as applicable, and some required notices from the pharmacy.

DISCLOSURE

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The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.