If there is a situation where you may have lost or forgotten your card and had your prescription filled at an in-network pharmacy, you may be eligible for reimbursement of the cost you paid.
To find out, click here to fill out the direct member reimbursement form to submit for review: DMR Form.
Yes! Click here to see a list of your patient’s covered medications: Formulary. Please note that the formulary is subject to change. Click here to see a summary of your patient’s benefits.
One of the best ways to help your patient save on prescription costs is to have them fill their medications at BILH pharmacy. With BILH pharmacy being our preferred pharmacy partner, we have negotiated the best prices to allow our members, who are also your patients, to reduce costs and adherence barriers.
If a medication requires a PA, this means the health plan uses a specific criteria to decide whether the patient meets the guideline for receiving the drug prescribed. As a rule of thumb, please provide as much information as possible for us to appropriately make our determination in a timely manner for your patient. This may include trial and failure of previous therapies, specific lab values and test results, applicable dates, etc.
No problem! Log into your profile using the “Patient Login” link. Once logged in, go into the “Coverage & Benefits” module. You will find your member information there along with the ability to print an ID card or request a replacement card.
There are a few ways to check your benefits:
1. Click here to access your benefit summary document: Benefits.
2. Log into your profile using the “Patient Login” link. Once logged in, click on the “Coverage & Benefits” module.”
A prior authorization is a clinical program put in place for the prescription to be covered by your plan based on many reasons, such as safety and medical necessity. When this is required, the physician ordering the prescription must give reasons why they believe the medication is right for you. The health plan evaluates the information and decides whether you meet the criteria to safely receive the drug.
Yes! In fact, we encourage it. Exclusive to BILH pharmacies, click here to fill out the form to get your medications sent directly to your home: Request Transfer.
Log into your profile using the “Patient Login” link. Once logged in, click into the “Find Drug Info…” search bar and type in your drug. You’ll be prompted to fill in other information related to your prescription, then hit “Submit”. Scroll down to see prices at surrounding in-network pharmacies as well as safety and storage information for the drug itself. Please note that these pricings are estimates and may not reflect actual pricing. Be sure to check with your pharmacy.
Fill out the transfer request form to minimize your prescription costs: Request Transfer.