Pharmacy Coverage


Get the most from your pharmacy benefits

Is my medicine covered? Can I get my prescriptions delivered to me? Do I need any prior authorizations? 

You can learn the answers to these questions and more by signing in to our secure member web portal at HorizonBlue.com. Once you sign in:

  • Click Doctors & Care
  • Click Prescriptions
  • Click Go to Your Prime Therapeutics

You’ll be redirected to MyPrime.com, the Prime Therapeutics website. Prime Therapeutics is our pharmacy benefit manager. 

MyPrime.com is your source for your pharmacy needs

You have 24/7 access to information and tools so you can get the most from your pharmacy benefits. Sign in to MyPrime.com to:

  • Find out which generics are available
  • Save money by enrolling in home delivery service
  • Find a participating pharmacy near you

Keeping you safe 

Some prescription medicines have quantity limits or require an approval process called prior authorization (PA). These safeguards are in place to help protect our members and their families.
To find out if a medicine has a quantity limit or requires PA, review your drug formulary online. Once signed in:

  • Click Medicines and select Find medicines from the dropdown menu.
  • Scroll down to Helpful documents and click the drug formulary link

How to Request a Formulary Exception

If your doctor feels that a specific medicine is medically necessary for you, but it’s not covered under your pharmacy benefits, your doctor can request an exception by:

  • Calling 1-888-214-1784, 24/7.
  • Completing a Request for Prescription Drug Coverage Exception form. The form is available at MyPrime.com in the Forms section and covers PA, quantity limits and tier exception requests. Your doctor can also download this form from the Plan Documents page.

Need help? 

If you need help with your pharmacy benefits, call Pharmacy Member Services at 1-800-370-5088, 24/7.

 


This article is for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Talk with your doctor about any questions about your health.