Pharmacy | Medical
Pharmacy – Retail & Delivery

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How It Works

Retail Pharmacies

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

Prime Therapeutics is the current Pharmacy Benefit Manager for Duval County Public Schools.

Member Services

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.

Covered Expenses

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

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

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 Exception

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.

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.

 

HMO PPO1
(Formerly Non-Contributory Plan)
PPO2
(Formerly Contributory Plan)
HDHP
(High Deductible Health Plan*)
30-Day Supply
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.