Pharmacy Programs

These pharmacy programs are available for members.

Prior Authorization/Step Therapy Program

View the Blue Cross and Blue Shield of Montana (BCBSMT) 2015 Standard UM Program Overview . This document will help you determine which prior authorization form is used for the medication being prescribed.

Download Prior Authorization and Step Therapy fax forms from the Prime Therapeutics website using the following links:

If you have questions or concerns regarding these programs, please call Prime Therapeutics at 888-723-7443.

Specialty Pharmacy Program

Your prescription drug benefit may include a specialty pharmacy program through Prime Therapeutics Specialty Pharmacy (Prime Specialty Pharmacy).

Specialty medications are those used to treat serious or chronic conditions. Examples include hepatitis C, hemophilia, multiple sclerosis, and rheumatoid arthritis. These drugs are typically given by injection, but may be topical or taken by mouth. They often require careful adherence to treatment plans, have special handling or storage requirements, and may not be stocked by retail pharmacies.

View the Specialty Pharmacy Program Drug List , which includes a reminder about coverage for self-administered specialty medications.

When you purchase specialty medications through Prime Specialty Pharmacy, you can have your self-administered specialty medications delivered directly to you, or to your doctor's office. You also receive at no additional charge:

  • Support services for managing your drug therapy
  • Educational materials about your particular condition
  • Help with managing potential medication side effects
  • 24/7/365 customer service phone access

Note: Prime Therapeutics Specialty Pharmacy LLC (Prime Specialty Pharmacy) is a wholly owned subsidiary of Prime Therapeutics LLC, a pharmacy benefit management company. Blue Cross and Blue Shield of Montana (BCBSMT) contracts with Prime Therapeutics to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. BCBSMT, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.

Mail Service Program

Mail Order Pharmacy Services

It is recommended that you use mail order services to fill your maintenance or long-term prescriptions in order to reduce your out-of-pocket costs. Depending on your pharmacy benefit, using mail order services can provide more medication at a reduced cost. You can obtain up to a 90-day supply of long-term (or maintenance) medications. Maintenance medications are those drugs you may take on an ongoing basis to treat conditions such as high cholesterol, high blood pressure or diabetes. View the Maintenance Drug List  to see if your medication is included. Short-term prescriptions, such as a 10-day prescription for antibiotics or acute pain medications, should be filled at your local retail pharmacy.

PrimeMail®

PrimeMail is an additional feature through Prime Therapeutics that offers our members prescription mail order services. PrimeMail is located in Albuquerque, New Mexico.

When you log in to Blue Access for MembersSM and visit your Rx Drugs page, you can use the online order form, print an order form to mail or ask that PrimeMail get in touch with your doctor to request a new prescription.

Ridgeway Pharmacy

Ridgeway Pharmacy, located in Victor, Montana, is an independent company that provides mail order prescriptions to our members.

Visit the Ridgeway Pharmacy website  for more information.

Vaccine Program

If you have coverage through Blue Cross and Blue Shield of Montana (BCBSMT), vaccinations may be covered under the medical benefit or prescription drug benefit, based on your plan. Select vaccines can be conveniently administered at a pharmacy near you. These vaccines can help protect you and your covered family members from illnesses such as the flu, pneumonia, shingles, meningitis, HPV, diphtheria and tetanus.

To see which vaccines are covered under your plan, check your benefit materials for details and any necessary copays. Or, you can call the Pharmacy Program number on the back of your ID card.

  • The select vaccines  covered under the prescription drug benefit are conveniently administered at a participating vaccine network pharmacy. Just hand your ID card to the pharmacist.
  • To find a participating pharmacy near you, see the list of Montana participating pharmacies , a national list of participating pharmacies , or you can call the number on the back of your ID card.
  • Before you go, be sure to confirm the location’s participation and hours, vaccine availability and ask about any other age limits, restrictions or requirements that may apply.