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In an effort to help hold the line on escalating prescription medication costs,
Arkansas Blue Cross provides a Pharmacy Program to help maintain quality health
The information in this section will give you an overview of the Pharmacy Program
and help you find answers to questions about how employees can best use their pharmacy
benefits. Specific details about each employee's pharmacy benefits should be discussed
with a Caremark customer service representative.
The Pharmacy Program is designed to eliminate the need for claim forms when using
a participating pharmacy. Pharmacy claim forms are provided upon request.
The Arkansas Blue Cross/Health Advantage Pharmacy Program, administered through
Caremark, contracts with more than 64,000 pharmacies nationwide to ensure employees
have access to the medications they need wherever they go.
After a prescription is filled, the pharmacist will store the personal prescription
history in a state-of-the art system to alert the pharmacist to dangerous drug interactions,
allergies, sensitivities to medications and chronic ailments. These quality assurance
measures help to protect the employee and enhance the quality of care.
The Pharmacy Program offers benefits to customers and their covered dependents,
including the following:
When an employee presents an ID card, participating pharmacists (working with the
employee's physician) can closely monitor medication therapy.
Pharmacists will be able to determine whether:
Arkansas Blue Cross members will receive an ID card to be used for both medical
The Pharmacy Program generally covers most medications that require a prescription
from a physician or other legally qualified person. Covered medications include:
Medications not covered by the pharmacy program vary according to the group's benefit
package. Please refer to your benefit certificate and Schedule of Benefits for more
information about each plan.
Employees with the Pharmacy Program benefit have access to thousands of participating
pharmacies throughout the nation, including most local and national chain pharmacies.
Participating pharmacies collectively are referred to as the pharmacy network.
To find a participating pharmacy, employees may ask their pharmacists if they are
members of the Caremark network, or call the toll-free number on their ID card for
information on the nearest participating pharmacies. Access to the online pharmacy
locator can be found at: www.arkansasbluecross.com.
When employees go to a participating pharmacy to have their prescription filled,
they must present their ID card to the pharmacist along with their prescription.
At the time of purchase they will be expected to pay coinsurance and/or a copayment
and/or deductible, based on their group's Schedule of Benefits. The pharmacist will
submit an electronic claim for reimbursement for the remainder of the payment.
There are no claim forms to complete, but employees will be asked to sign a log
at the pharmacy as evidence they received the medication for insurance verification.
If an employee uses a nonparticipating pharmacy in their state of residence, the
prescription is not covered through the Enterprise Pharmacy Program and is not eligible
for reimbursement from the insurer.
Out of State
If an employee uses a nonparticipating pharmacy outside their state of residence,
the prescription is not covered through the Pharmacy Program and is not eligible
for reimbursement from the insurer.
Choosing generic medications, rather than brand names, will save your employees
Brand-name medications are those for which a pharmaceutical company holds a patent.
After the patent expires, other manufacturers may produce the same drug. These medications
bear the same chemical or generic name and, by law, must meet the same standards
for purity, strength, quality and safety.
Generic medications are therapeutically equivalent to the original brand name but
usually cost significantly less. When employees select the less expensive generic
form of a medication, they save money by reducing the copayment and/or coinsurance
amount they pay.
Most groups have a generic incentive as part of their benefit package. The generic
incentive works this way:
The toll-free number for Caremark (1-800-863-5561) is on the back of your employees'
ID cards. Caremark can provide information on:
Q. How does the employee use the ID card at the pharmacy?
A. The employee gives the pharmacist a health plan ID card when requesting
the prescription (new or refill). The employee provides the pharmacist with: patient
name, date of birth and gender. The employee pays the pharmacist the appropriate
amount (deductible or copayment and/or coinsurance) in accordance with the group's
Q. Why should the employee use a participating (network) pharmacy?
A. The employee receives maximum benefits (and processing convenience) when
using a participating pharmacy.
Q. What if the employee obtains a prescription medication from a nonparticipating
A. If an employee uses a nonparticipating pharmacy, the prescription will
Q. What is a specialty medication and why is it required to be filled at a specialty pharmacy?
A. A medication is designated as a specialty medication because of how it is administered,
its approved indication, its unique nature, or its high cost. These medications usually require
special handling and home storage demands, crucial patient education and careful monitoring. Such
medications include, but are not limited to, growth hormones, blood modifiers, immunoglobulins and
medications for the treatment of hemophilia, deep vein thrombosis, hepatitis C, Crohn’s disease,
cystic fibrosis, multiple sclerosis and rheumatoid arthritis.
Q. What is a prior authorization?
A. A program that requires physicians to obtain certification of medical necessity prior to drug
dispensing due to administration, its approved indication, its unique nature, or its high cost.
Q. Can an employee get a 90-day supply of medication?
A. Certain medications, referred to as maintenance medications, can be obtained at a 90-day supply
if the member has already filled a 30-day supply of that medication. Maintenance medications are usually
prescribed to treat conditions of a long-term or chronic nature, such as diabetes, arthritis and high blood pressure.
Q. How do employees get prescriptions filled when traveling?
A. When employees plan to travel out of state and are on maintenance (ongoing,
planned) medication, they may be able to obtain enough medication to last until
they return home by contacting their usual pharmacy in advance.
If an employee becomes ill or injured while traveling, he or she may use any network
pharmacy; he or she will need to show the pharmacist a health plan ID card.
The network pharmacy can submit the claim electronically and the employee will pay
The employee also can pay for the medication "out-of-pocket" and submit a claim
for reimbursement later.
NOTE: Employees should ask if the pharmacist is a member of the Caremark
network; it may save them the trouble of filing.
Q. Can a family member pick up an employee's prescription?
A. Yes, another responsible member of the family may obtain the medication
at the employee's request.
Q. Do purchases of prescriptions with the pharmacy program go toward meeting the
true out of pocket (TrOOP)?
A. Copays, coinsurance and deductibles on covered prescription costs all count toward meeting the true out of pocket (TrOOP) maximums.
Q. On a newly enrolled group, does the deductible that an employee met with a previous
carrier count toward meeting the pharmacy program deductible (if any)?
A. Meeting a drug deductible with a previous carrier does not count towards
the annual drug card deductible when a group enrolls with Arkansas Blue Cross.
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