FAQs

Please visit the BILH Benefits Central website to learn more about your prescription benefits.

As part of the InScript clinical program, members on highly complex medications may be required to adhere to InScript’s Site of Care Management program. The Site of Care Management program ensures that you are being clinically managed by the appropriate medical provider to ensure the most optimal clinical outcome. If this program is required for prescription coverage, you will need to obtain a second opinion from our network approved provider. When your prescription requires you to participate in the Site of Care Management program, you will be contacted by the InScript Member Services team. 

As part of the InscriptRx clinical program, members on highly complex medications may be required to adhere to InscriptRx’s Medication Therapy Management (MTM) program. The MTM program is a pharmacist led program to optimize therapeutic outcomes, clinical quality, and ensure medical appropriateness. When your prescription requires you to participate in the MTM program, you will be contacted by the InscriptRx Member Services team.

Impacted Medications:

• Bydureon
• Byetta
• Mounjaro
• Ozempic
• Rybelsus
• Saxenda
• Soliqua
• Trulicity
• Victoza
• Wegovy
• Zepbound

Your BILH health plan administered by InscriptRx has adopted unique coverage criteria for glucagon-like peptide-1 (GLP-1) medications. Plan members using GLP-1s for weight loss specifically are required to complete a Medication Therapy Management (MTM) virtual visit with the BILH Weight Loss Management Clinic.

To assist with this process, the BILH Weight Management Team will call to schedule an appointment or they can be reached at 781-352-6551 to answer questions or to proactively schedule your visit.

What to expect during an MTM appointment: A weight loss-specialized pharmacist will assess and evaluate your clinical condition, review any side effects, answer any questions you have about your medications, and discuss lifestyle modifications to enhance your outcomes. 

For all indications for GLP-1s, please use this form to submit a prior authorization for the product.

The BILH Copay Assistance Program helps reduce out-of pocket costs incurred by members of our employer-sponsored health insurance plans for certain high-cost medications, called “specialty medications”. Make sure your patients and their covered dependents know they will be contacted if they take a qualifying specialty medication. They can also call 617-589-1162 to confirm if their specialty medication is eligible for financial support through the program.

View Formulary

A prior authorization (PA) is a clinical program to ensure safety and medical necessity. If you are prescribing a drug that requires a PA, please fill out our general PA form.

As part of the InscriptRx program, weight loss GLP-1s are required to follow certain clinical criteria. If you are prescribing a GLP-1 drug for any indication, please use this form to submit a PA for a product.

Please visit the BILH Benefits Central website to learn more about your prescription benefits.

If you have an active authorization with CVS, you will not need a new one as they will be transferred over to us.

**Please note that some prior authorization not provided by CVS Caremark will not be available to InScript and will need a new prior-authorization.

A real-time benefits check is a feature that allows providers to search if a drug is covered under the patient’s pharmacy benefit and if there are any associated restrictions. This feature can be utilized during the patient visit or during prescribing. Providers can also run a test claim and submit a prior authorization, if applicable, directly from the program. You can utilize this feature if the healthcare system electronic health records are integrated with real-time benefits check.

The biggest advantage of utilizing this feature is to minimize the time between the moment a prescription is given to the patient and the time the patient starts taking the drug.