Pharmacy | 2022 | Medical
Pharmacy – Specialty Prescriptions

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How It Works

(Out-of-network pharmacy expenses are not covered; For Retail & Mail-order medications, see Pharmacy – Retail & Delivery.)

Specialty Pharmacies

Florida Blue has two preferred specialty pharmacies. Members may choose between CVS/Caremark Specialty Pharmacy and Accredo Specialty Pharmacy. CVS/Caremark Specialty Pharmacy will remain in-network.

CVS/Caremark Specialty Pharmacy

CVS/Caremark Contact

cvsspecialty.com

1-800-237-2767 (TTY: 711)
or 866-278-5108

Accredo Specialty Pharmacy

Accredo Contact

accredo.com/flblue
888-425-5970
Accredo Health Group, Inc.
1640 Century Center Parkway,
Memphis, TN 38134

Accredo, one of the top specialty pharmacies in the nation, offers a high level of customer service. Members have access to Accredo’s mobile apps; free standard delivery in weather-proof packaging; specialty-trained pharmacists, nurses and insurance representatives; and automatic refill reminders.

  • Member co-payments will remain the same. For members with coinsurance or who pay out of pocket until a deductible is met, costs could be lower.
  • Accredo offers members health condition-specific clinical support and education.
  • Accredo’s mobile app makes it easy manage your prescriptions.
  • Turnaround time for refills is typically 24-48 hours.
  • To self-register, go to accredo.com/flblue. Create an account, add a payment method and update your profile. You may view your active prescriptions and send your refill order when you’re ready or calll Accredo at 888-425-5970.

Payments can be made via any of these methods:

  • By debit or credit card (American Express, Discover, MasterCard or Visa). The charge will appear on your credit card statement as Accredo.
  • Through your checking account.
  • Through a flexible spending account (FSA).
  • By mail via check.

For payments, send checks to:

Accredo Health, Inc.
PO Box 954041
St. Louis, MO 63195

NOTE: Please include your patient account number on your check.

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.

NON-CONTRIBUTORY PLAN CONTRIBUTORY PLAN HIGH DEDUCTIBLE HEALTH PLAN (HDHP)*
30-Day Supply Calendar Year Deductible (CYD) MUST be met then:
Generic - Formulary $7 $7 CYD + $7
Brand - Formulary $25 $25 CYD + $25 + 10% Coinsurance
Non-Formulary $40 $40 CYD + $40 + 10% Coinsurance
Specialty Injectables $55 $55 CYD + $55 + 10% Coinsurance
90-Day Supply Calendar Year Deductible (CYD) MUST be met then:
Generic - Formulary $14 $14 CYD + $14
Brand - Formulary $50 $50 CYD + $50 + 10% Coinsurance
Non-Formulary $80 $80 CYD + $80 + 10% Coinsurance
*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.