August 12, 2024
Starting Sept. 1, 2024, an optional 30-Day supply limit pharmacy benefit program is available for some employer groups with Prime Therapeutics. Two benefit options are available as part of the program: GLP-1 30-Day Max and Anti-Obesity 30-Day Max.
This new program aims to reduce drug waste and cost of care associated with GLP-1 and/or anti-obesity drug therapy.
The program limits fills to 30 days of all applicable GLP-1 and/or anti-obesity drugs (oral and injectable), depending on the member’s pharmacy benefits. The benefit may include the following drug products: Mounjaro, Ozempic, Orlistat, Phentermine HCL, Qsymia, Saxenda, Trulicity, Wegovy and Zepbound.*
The categories and medications included may vary according to employer group selections. Program details and applicable prior authorization requirements are based on the member’s pharmacy benefits.
Which members are affected? This program is an employer group option that may apply to some of our commercial members. Always check eligibility and benefits first for each member at every visit. This step confirms membership and other details, such as prior authorization requirements and utilization management vendors, if applicable.
- For services/drugs under the member’s medical benefit, check eligibility and benefits electronically via Availity® Essentials or your preferred vendor prior to rendering care.
- For drugs under the member’s pharmacy benefit, call the number on the member’s ID card before prescribing.
If your patients have questions, they can call the number on their member ID card for Blue Cross and Blue Shield of Illinois, log on to Blue Access for MembersSM or visit MyPrime.com.
GLP-1 New to Therapy: We previously announced an optional pharmacy benefit program for members beginning GLP-1 therapy. It became available April 1, 2024, for some employer groups with Prime Therapeutics. Learn more.
*This list is subject to change. Trademarks are the property of their respective owners.
The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Physicians are to exercise their own medical judgment. Pharmacy benefits and limits are subject to the terms set forth in the member’s certificate of coverage which may vary from the limits set forth above. The listing of any drug or classification of drugs is not a guarantee of benefits. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions.
Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. Regardless of benefits, the final decision about any medication is between the member and their health care provider. If you have any questions, call the number on the member's ID card for BCBSIL.
Prime Therapeutics LLC is a pharmacy benefit management company. BCBSIL contracts with Prime Therapeutics to provide pharmacy benefit management and other related services. BCBSIL, as well as other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC. MyPrime.com is an online resource offered by Prime Therapeutics. Availity is a trademark of Availity, LLC., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products or services they offer.