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Pharmacy Services

Your plan may have prescription drug coverage administered by Prime Therapeutics LLC (Prime). Look at your member ID card for the Prime logo or read your SPD or Benefit Booklet to find out if this is part of your benefits.

If you have pharmacy benefits through Horizon BCBSNJ, we have a quality process for select prescription drugs or prescription drug categories that have the potential for misuse, abuse and adverse effects. These prescription drugs are commonly used for purposes other than those approved by the Food and Drug Administration (FDA). Through our prior authorization process, we check for medical necessity and appropriateness based on FDA-approved use, peer review, clinical literature and national standards.

Eligibility for coverage of some drugs cannot be determined from the claims submitted. We may need additional information from your doctor. In these cases, your doctor must submit a request for prior authorization or a request for quantities above the plan limit.