Pharmacy

For your convenience, click on the links below to access our complete Medication Guide. For your convenience, we've also included a link to Medline, the National Library of Medicine's database of references to more than 11 million articles published in 4,600 biomedical journals.

• Medication Guides
  A listing of brand and generic prescription drugs that may be covered under one of our pharmacy plans. For complete coverage details, please have your patients refer to their Pharmacy Program Endorsement.
  
  
• Responsible Quantity (PDF)
  Responsible Quantity is an initiative to ensure that prescription drug coverage reflects drug manufacturers' and FDA dosing guidelines.
  
  To request a prior authorization for a medication included in the Responsible Quantity program, download the Quantity Limit Prior Authorization form, complete and fax to 1-877-480-8130.
  
  
  • Quantity Limit Authorization (PDF)
    Authorization requests for use of over 4,000 mg of acetaminophen per day cannot be approved.
    
    
• Responsible Steps
  Responsible Steps is an initiative to ensure the use of a designated or prerequisite drug(s) first in order for coverage of the drug included in the Responsible Steps program.
  
  To request a prior authorization for a medication included in the Step Therapy program, download the appropriate Step Therapy Prior Authorization Request form, complete and fax to 1-877-480-8130.
  • Responsible Steps Program Information and Authorization Forms (PDF)
  
  
  
• Prior Authorization
  Prior Authorization assures that specific clinical criteria are met in order for coverage of the drug included in the Prior Authorization program.
  
  To request a prior authorization for a medication included in this program, download the appropriate form, complete and fax to the number at the bottom of the form.
  • Prior Authorization Program Information and Authorization Forms (PDF)

  Faxed Exception Forms with all required information are processed within 10 calendar days from the date received from the provider. Faxed Exception Forms with missing information may require up to 15 working days to be completed, provided missing information can be readily obtained.

• Generic Co-Pay Waiver Program
  A list of commonly prescribed drugs where a member may discuss with their physician the opportunity to switch to a less costly generic alternative. Blue Cross Blue Shield of Florida will waive the initial co-pay when a member switches to a generic alternative. This link provides a list of the medications covered under the program. This program may not apply to all Blue Cross Blue Shield of Florida Pharmacy products.
  
  
  • Generic Co-Pay Waiver Program (PDF)
    
    
• Medline
  The National Library of Medicine (NLM) collects and provides information and research services in all areas of biomedicine and health care.
  
  
• Pharmacy Claim Filing Instructions
  Participating pharmacies should submit claims for covered prescriptions to Prime Therapeutics, LLC. It is necessary that all Blue Cross and Blue Shield of Florida claims be transmitted using a portion of the contract number on the member's ID Card. The first three alpha characters in the contract number are not part of the member ID number and should not be used on submissions of claims. The member ID number begins with the letter H.
  
  
  • Process Control Number (PCN) for BlueScript, Mediscript and BlueCare Rx members is FLBC and the member ID number is the letter H followed by 8 or 10 numeric digits.

  Claims should be transmitted using Bin Number 012833. For assistance or questions related to claim filing for covered prescriptions, contact the Prime Pharmacy Help Desk at 1-888-877-6323 for non Medicare Part D or 1-888-877-6420 for Medicare Part D.

  To view examples of our members' Identification (ID) Cards, simply click on the following link to our current fast tracker.
  
  Identification (ID) Card Fast Tracker (PDF)