Effective January 1, 2017, regardless of renewal date, CVS pharmacies and CVS pharmacies in a Target® store will no longer be a part of Blue Cross and Blue Shield of Texas' (BCBSTX) standard pharmacy network for members with pharmacy benefits administered by Prime Therapeutics®.
This network change impacts fully insured group and retail market (Metallic plan small group and individual) members. It does not impact Medicaid or Medicare plans at this time.
Working closely with Prime Therapeutics, BCBSTX continuously assesses our pharmacy networks and offerings to ensure we are maintaining affordable benefits for our members, including obtaining competitive reimbursement rates from participating pharmacies within Prime's network. Through ongoing negotiations, CVS Pharmacy
® requested a higher reimbursement rate for generic prescriptions as compared to other pharmacies. Therefore, BCBSTX has made the decision to no longer include CVS pharmacies within the pharmacy network.
Members will continue to have access to more than 55,000 nationwide pharmacies in network (without CVS), with more than 4,000 located within Texas. This includes many major pharmacy chains such as Walgreens, Walmart, Kroger, HEB, Brookshire's and many independent pharmacies. In every county where we have a presence, we exceed network adequacy standards set by Texas with the remaining pharmacies in network.
BCBSTX is committed to helping our members find the most convenient alternative for their pharmacy coverage needs. Impacted members, who have had recent CVS claims, will be notified in October with a letter. This letter will provide information on how to find an alternative network pharmacy, as well as how to transfer any current refill/new prescriptions for their new pharmacy.
Stay tuned for more information about this pharmacy network change.