BlueChoice HealthPlan of South Carolina has simplified the way you prescribe medicine and get prior authorizations. Effective Jan. 1, 2020, our new Pharmacy Benefit Management (PBM) will offer most group plans services in a clinical program bundle. These clinical programs reflect our best-in-class strategies for effective management of prescription drug cost and utilization. The bundle includes:
The bundle includes:
- Prior Authorization (PA)
- Quantity Management
- Step Therapy
- Opioid Risk Management Solution
- Safety Management
- Retrospective Gaps in Care
- Medication Adherence Program
- Specialty Medical Benefit Management
Also included are two tools to assist you with prescribing medications (pharmacy benefit) and getting PAs (medical benefit) for your patients: PreCheck MyScript® and MBMNow.
Prescription Drugs (PreCheck MyScript)
PreCheck MyScript is a Real Time Benefit Check technology tool that makes it easy to get patient-specific prescription drug cost and coverage information at the point of care. PreCheck MyScript displays actual drug cost information based on the patient’s benefit plan design which allows you the ability to discuss medication options with your patients. This advanced tool also alerts you when a PA is required for a prescribed drug.
PreCheck MyScript may be available within your electronic medical record (EMR) system and referred to as Real Time Benefit Check or myBenefit Check, depending on the platform. You can also access PreCheck MyScript on the Pharmacy pages of our websites, www.BlueChoiceSC.com or www.SouthCarolinaBlues.com, or by going directly to the portal’s link, https://provider.linkhealth.com.
Prior Authorizations for Medical Specialty Drugs (MBMNow)
MBMNow is an electronic PA tool for some medical (injectable/infusible) specialty drugs that will take the place of Novologix, CVS/Caremark’s online PA tool. The MBMNow tool provides a set of comprehensive capabilities including care management, utilization management, network administration and claims administration. This tool allows you to check the status and follow-up on a PA request and is available via single sign-on access through My Insurance ManagerSM.
If you have questions about this bulletin, please send an email to firstname.lastname@example.org or submit your question using the Provider Education Contact Form. As additional information, our members have received notices regarding the pharmacy benefit manager changes.
Frequently Asked Questions
PreCheckMyScript – Prescription Drugs
1. What groups are impacted by this change?
- BlueCross and BlueChoice HealthPlan fully-insured individual, small group, large group and Administrative Service Only (ASO) plans
- Medicare Advantage plans
- The following plans are NOT impacted:
- ASO plans for which we do not administer the pharmacy benefit and do not provide specialty drug medical management services.
- State Health Plan members will continue using Express Scripts to administer their pharmacy benefit.
2. Will members receive a new identification (ID) card?
Members who have their pharmacy and medical benefits through one of our health plans will receive a new ID card. Members can also get an electronic version of their ID card by logging into My Health Toolkit®.
3. How does PreCheck MyScript work?
PreCheck MyScript is a Real Time Benefit Check solution that provides patient specific prescription drug cost and coverage information at the point of care in real time. PreCheck MyScript runs a trial claim through our pharmacy claim platform so you can:
- Tell your patient the precise cost of the medication.
- Evaluate therapeutically equivalent medication alternatives, if available, covered under the member-specific benefit design.
- Understand medication coverage, including which medications may not require a prior authorization
- Submit a PA, often receiving results in seconds.
4. Why should I use PreCheck MyScript?
PreCheck MyScript allows you to discuss cost and options with your patient while they are in your office and before the prescription is sent to the pharmacy. This can remove cost barriers for patients which can lead to increased medical compliance.
5. How does PreCheck MyScript make it easier to submit a PA request?
With PreCheck MyScript, there are no forms to fill out and there is no need to send a fax or make a phone call. A PA request can be submitted electronically through the tool you are already working in.
6. How accurate is PreCheck My Script?
PreCheck MyScript shows:
- The member’s out-of-pocket cost based on the medication being prescribed.
- The pharmacy selected.
- The member’s benefit plan coverage including the deductible.
- The pricing in real time. The price you see on the screen is what is in our pharmacy claim platform for that drug for that particular member’s benefit plan. The pricing information and Prescription Drug List (PDL) are accurate at that point in time and are subject to change.
7. How does PreCheck MyScript help my patients?
When you prescribe a medication that needs a PA, you will see an alert on your electronic medical record (EMR) screen. The member’s plan-specific information and some questions specific to that drug are pre-populated. Once all required fields are completed, submit the request and you may receive the determination within seconds. PreCheck MyScript also tells you if a prescription is not covered or non-preferred, which is a cost savings to the patient.
8. Which EMRs are currently using the PreCheck MyScript tool?
PreCheck MyScript is in a variety of EMRs including, but not limited to AllScripts, Athenahealth, DrFirst, MEDITECH, NewCrop, and select installations of Epic and Cerner. The tool is embedded in the e-Prescribing work flow and may be referenced by a different name within the specific EMR such as “Real Time Benefit Check” or “myBenefit Check”.
9. Is there another way to access PreCheck MyScript?
PreCheck MyScript can be accessed on the Pharmacy pages of our websites, www.BlueChoiceSC.com or www.SouthCarolinaBlues.com. You can also go directly to the portal at this link, https://provider.linkhealth.com. You will need to register to create an account to utilize the tool.
10. Will the new PBM program changes affect members?
Our members have been notified of the PBM program changes and we anticipate no transition issues.
MBMNow – Medical Specialty Drugs
1. How do I obtain access to the MBMNow authorization system?
You can access the MBMNow web portal when you log into My Insurance Manager through www.BlueChoiceSC.com or www.SouthCarolinaBlues.com.
2. What ways can I get PAs for medical specialty drugs:
- Online through My Insurance Manager, the preferred method
- Call 877-440-0089
- Fax to 612-367-0742
3. How do I get support services for the MBMNow tool?
Support services for MBMNow is available Monday – Friday from 8 a.m. to 8 p.m. (EST). If you have any technical problems or comments, you may review the MBMNow User Guide at www.BlueChoiceSC.com or www.SouthCarolinaBlues.com on the Pharmacy page, or send an email to:
Please do not include protected health information (PHI) when sending email messages.
4. Will the current medical policies apply or will new medical policies for PAs for MBMNow be implemented, for example step therapy requirements?
The current medical policies and specialty medical drug policies are applied via the MBMNow software.
5. How will I know if a PA is required by the patient’s insurance plan?
We encourage providers to utilize My Insurance Manager to verify eligibility, benefits, and the necessity of PA requirements at each patient visit.
6. Will all PA requests for specialty medical drugs have to be submitted online or can they be faxed?
The PA requests can be faxed to 612-367-0742. The preferred method is electronically through the MBMNow tool, which is a faster more efficient way to process and track your PA requests.
7. Can additional clinical information be faxed after obtaining a PA?
Yes, however, our preferred method to submit additional clinical information is electronically through the MBMNow tool. You may also call 877-440-0089 with the requested information, if applicable.
8. Is a PA required for a drug that we buy and bill?
Yes, PAs are required for specialty drugs that providers buy and bill. The current drug lists are available on www.BlueChoiceSC.com or www.SouthCarolinaBlues.com on the Pharmacy page.
9. Is a new PA required when a patient’s treatment plan changes with additional drugs?
A new PA is required when additional medical specialty drugs are prescribed.
10. Will I have to go to the MBMNow portal to check the status of an approved or denied PA request?
We encourage you to go to the MBMNow portal to check the status. You will also receive a notification via fax once a determination has been reached.
11. What method of electronic notifications will I receive when using the MBMNow tool?
You will receive a fax notification if more clinical information is needed to review a case and to advise of PA request determinations.
CVS Caremark is a division of CVS/Health, an independent company that currently provides pharmacy services on behalf of BlueCross.
BlueChoice HealthPlan of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.