Alabama residents with Blue Cross and Blue Shield of Alabama insurance who have their prescriptions filled at CVS drug stores will have to pay full price for their medications or go elsewhere for their insurance to help cover the cost.

Blue Cross and Prime Therapeutics have developed new preferred pharmacy networks as of Jan. 1 that do not include CVS, according to Koko Mackin, vice president of corporate communications and community relations for Blue Cross.

“This change was made to help offset the continuous rise in prescription drug costs,” Mackin said. “The new pharmacy networks will provide the best medications for the best price.”

Blue Cross and Blue Shield of Alabama is part owner of Prime Therapeutics, which is a pharmacy benefit manager based in St. Paul, Minnesota.

Mackin said CVS is the only national chain not participating in the new networks.

“Prime was able to secure more cost-effective prescription drug prices from Walgreens and other pharmacies,” Mackin said when asked why CVS is not in the new networks.

Gary Serby, director of corporate communications for CVS in Woonsocket, Rhode Island, said it was not the company’s choice to be excluded from the Prime Therapeutics network.

The more than 2.2 million Alabama residents covered by Blue Cross likely will have to transfer their prescription medicine shopping from CVS to other drug stores.

Jessica Parker, of Decatur, learned of the change late Wednesday afternoon at the CVS on Beltline Road Southwest when Blue Cross would not cover part of the cost of her prescription.

“That makes me livid,” Parker, 35, said after leaving the drug store. “I’m supposed to take my medication today. Now, I won’t be able to.”

Parker said she has used CVS for about 10 years to fill the five prescription medications she takes. She said she did not receive any notice from Blue Cross about the change involving CVS.

She left CVS at dusk Wednesday to go to Walgreens.

“I’m going to call the insurance company on the way and give them hell,” she said.

Louise Jones, executive director of the Alabama Pharmacy Association, said the association was notified last fall of Blue Cross’ new preferred provider network. She said the association believes in freedom of choice for drug stores and the public.

“The APA supports a system that provides an open network for pharmacies that want to participate,” she said. “We think patients should be able to choose where they go to get their medications.”

The Alabama Department of Insurance has no authority over the matter, spokesman Stephen Holmes said.

Chains such as Walgreens and Wal-Mart are in the new networks, along with many local independent drug stores, Mackin said. She said consumers can find a participating drug store online at AlabamaBlue.com/pharmacy.

Any pharmacy network changes for employer plans will occur when the employer’s plan is renewed, which can be any time during the year, Mackin said.

Prime Therapeutics and Walgreens announced their alliance jointly last fall.

Blue Cross or their affiliates in 14 states own Prime Therapeutics, which is the fourth-largest pharmacy benefit management company in the country. Blue Cross in other states in the ownership group includes Florida, Texas, California, North Carolina and Minnesota.

A pharmacy benefit manager administers prescription drug programs, according to the American Pharmacists Association.

A pharmacy benefit manager develops and maintains a list of prescription drugs covered by an insurance plan, negotiates discounts and rebates with drug manufacturers, contracts with pharmacies, and processes and pays prescription drug claims, the association said.

CVS’ loss of Blue Cross business comes on the heels of being dropped from the network for TRICARE, the health insurance program for active U.S. military members and veterans, on Dec. 1.

CVS Health Corp. projects it will lose more than 40 million prescriptions in 2017 because of the new pharmacy networks that exclude CVS drug stores, according to the company’s third-quarter earnings report.

Serby said 180 of CVS’ more than 9,600 drug stores are in Alabama.

“We have no announcement on any closings,” he said.

keith.clines@decaturdaily.com or 256-340-2438. Twitter @DD_KeithClines.

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(12) comments

Steve Flory

This depends completely on your policy. Mine is still in network. It is mostly the Obama care policies.

John Mays

I received notice from BCBS that Rite Aid was no longer in network.

Boyle Frank

I received notice that CVS is still a BCBS provider for State employees plan 13000.

John Holliday

What about those of us employed by TVA? We are covered by BC/BS of Tennessee for our RX coverage. Is it all BC/BS or just the Alabama BC/BS

Pamela Blakely

Will CVS start selling beer and cigarettes if they stop being a pharmacy?

Alan Lee

CVS still fills my subscriptions. BC/BS has been using a third party for prescriptions for years. Just filled 3 scripts yesterday. Same copays I've always paid.

Boyle Frank

Same here. Still filling my BC/BS prescriptions.

Craig Stover

CIGNA dropped CVS last year and now BC/BS. Has to make you wonder if somebody is dropping the ball on the CVS side if two major insurance companies have dropped them in the last year. BC/BS needs to update their in-network list, because if you click the link in this article, it still shows all the CVS pharmacies around me, in the Decatur and Hartselle area, as still in-network

John McJohnson

Depending on your policy, CVS may still be in-network until your policy renewal date.

Lori Ray

The changes in the preferred pharmacies occur at your renewal date. So at your renewal date that list should update.

Lori Ray

I ran into the same problem. What strikes me as odd is that some of the pharmacies that are still in the network are small, independent pharmacies like Payless and Bendall's, and The Pill Box. How in the world are they asking for less of a reimbursement than huge stores like CVS? I would think the volume of drugs purchased and sold by the larger stores would automatically lead to them being able to offer lower prices to the insurance companies. Anyone have any thoughts?

John McJohnson

I've heard that the reason CVS was cut was because Walgreens gave BCBS a lower rate in return for their biggest rival being cut from the list.

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