Pharmacy | MedicalPharmacy – Retail & Delivery
How It Works
Prime Therapeutics is a national network comprised of thousands of retail pharmacies. The network includes most major chains, discount, grocery and independent pharmacies, so there is a good chance that your local pharmacy is a participating member of the network. To find a local pharmacy, visit www.myprime.com and click “Find a Pharmacy” or contact Member Services.
Prime Therapeutics is the current Pharmacy Benefit Manager for Duval County Public Schools.
Visit Prime Therapeutics’ website, www.myprime.com, to view your plan design and copayment information, search for details on prescription medications, locate a participating pharmacy near you, and manage your home delivery prescriptions. For additional plan inquiries, you may call Member Services directly at 1-800-664-5295. For future reference, this number is listed on the back of your Florida Blue ID card.
Benefit ID Cards
Present your ID card when filling a prescription at the pharmacy. Should you need additional or replacement ID cards, please contact Member Services or visit www.floridablue.com to either request a new card or print a temporary card.
Federal legend prescription drugs, unless otherwise indicated;
- Drugs requiring a prescription under the applicable state law;
- Insulin, insulin needs and syringes on prescription; or
- Compound medications, of which at least one ingredient is a federal legend drug.
Medication Step Therapy
Step Therapy requires the previous use of one or more drugs before coverage of a different drug is provided. If your health plan’s formulary guide reflects that Step Therapy is used for a specific drug, your physician must submit a prior authorization request form to the health plan for approval. If the request is not approved, please remember that you always have the option to purchase the medication at your own expense.
Prior authorization is required on some medications before your drug will be covered. If your health plan’s formulary guide indicates that you need a prior authorization for a specific drug, your physician must submit a prior authorization request form to the health plan for approval. If the request is not approved, please remember that you always have the option to purchase the medication at your own expense.
Quantity limits are applied to certain drugs based on the approved dosing limits established during the FDA approval process. Quantity limits are applied to the number of units dispensed for each prescription. If your health plan’s formulary guide reflects that there is a quantity limit for a specific drug, your physician must submit a prior authorization request form to the health plan for approval. If the request is not approved, please remember that you always have the option to purchase the medication at your own expense.
Formulary exceptions are necessary for certain drugs that are eligible for coverage under your health plan’s drug benefit. Your physician must submit a formulary exception form to your health plan for approval. If the request is not approved by the health plan you may still purchase the medication at your own expense. The general form can be used if the drug you are requesting coverage for is not on the formulary list.
If a brand-name drug is prescribed without any provider dispensing instructions, an equivalent generic drug will be dispensed, unless the member chooses the brand-name drug. If the brand-name drug is dispensed, the member will pay the difference in the cost of the brand-name and generic drug. The cost difference between the generic and brand-name medication will not apply toward your deductible.
Generic medications contain the same active ingredients as brand-name medications, are just as safe and effective, and meet the same U.S. Food and Drug Administration standards for quality, strength and purity. However, generic drugs normally cost substantially less than their brand-name counterparts.
Formulary and Non-Formulary Medications
The Prime Therapeutics Formulary List is a guide for you and your doctor to refer to when filling out your prescriptions. If there is no generic medication available for your condition, there may be more than one brand name for you and your doctor to consider. Prime Therapeutics provides a list of formulary brand-name medications to help you and your doctor decide on medications that are clinically appropriate and cost-effective. If a drug you are taking is not on the formulary list, you may want to discuss alternatives with your doctor or pharmacist. Using drugs on the formulary list will keep your costs lower. A current drug list is available online or upon request by calling Member Services. To avoid paying higher copayments associated with non-preferred drugs, please take this list with you when you visit your doctor so he or she can refer to it when prescribing medications for you and your eligible family participants.
Prescription Copay Summary: Retail and Mail Order
Out of Network Retail and Mail Order Pharmacy expenses are not covered.
Note: Specialty Drugs are not available through Mail Order Pharmacy. For more information, please contact customer service at (800) 664-5295.
(Formerly Non-Contributory Plan)
(Formerly Contributory Plan)
(High Deductible Health Plan*)
|Generic - Formulary||$10 Copay||$7 Copay||$7 Copay||CYD + $7 Copay|
|Brand - Formulary||$30 Copay||$50 Copay||$50 Copay||CYD + $50 Copay + Coins.|
|Non-Formulary||$50 Copay||$80 Copay||$80 Copay||CYD + $80 Copay + Coins|
|Specialty Injectables||$80 Copay3||$100 Copay3||$100 Copay3||CYD + $100 Copay + Coins|
|90-Day Supply||2X Copay||2X Copay||2X Copay||2X Copay|
|*HDHP W/HSA: Rx costs go to deductible. Once deductible is met, then employee pays copay for generic and copay+10% for all other Rx.|