Some Insulin Drugs and Diabetic Test Strips May Be Available at a Lower Cost

If you live with diabetes, you know that one of the biggest challenges is keeping your blood sugar at close-to-normal levels. It’s important to maintain glucose levels as close to normal as possible to help reduce the chance of any diabetes-related health problems.

Taking your insulin medications as directed and using a blood glucose meter to check your blood sugar levels are vital to your diabetes care.

And if you have Prime Therapeutics (Prime) as your pharmacy benefit manager, you may now pay a lower amount (copay or coinsurance) when buying certain insulin medications and diabetic test strips.

$25 Insulin Copay Maximum

For some members with a BCBSMT health plan offered through their employer, there is now a $25 copay maximum (or cap) for up to a 30-day supply of certain insulin medications. This may apply when you get these insulin drugs at in-network pharmacies or from your home delivery program.

Log in to your Blue Access for Members^SM (BAM^SM) or myprime.com  account to see how much your insulin may cost.

Please note:

• Any dispensing and quantity limits will still apply.
• If your plan uses the Value Pharmacy Network, you will pay the $25 copay at a value pharmacy only. If you use a non-value or out-of-network pharmacy, you’ll pay the applicable cost-share for using that pharmacy, based on your plan benefits.
• For plans that do not have the Value Pharmacy Network, you may pay the $25 copay at any in-network pharmacy. If you use an out-of-network pharmacy, you’ll pay the applicable cost-share for using that pharmacy, based on your plan benefits.
• Based on your plan, you may need to meet the plan deductible first before any copay caps apply.

Lower Cost-Share for Some Diabetic Test Strips

Members may also now pay a lower cost-share amount when buying certain diabetic test strips at the pharmacy or through the home delivery program. 

Log in to your BAM or myprime.com  account to see how much your test strips will cost. Depending on your plan, you may now pay a lower cost for some diabetic test strips.

Any dispensing limits will still apply. You may also need to pay an added charge if you use certain pharmacies, such as a non-value pharmacy (for plans on the Value Pharmacy Network) or out-of-network pharmacy (for any plan).

This information is intended for members who have Prime Therapeutics (Prime) pharmacy administration. If you’re not sure if you have Prime, check your Blue Access for Members account, ask your benefits administrator, check the pharmacy information on your member ID card or call the customer service number on your member ID card.

Prime Therapeutics is a separate pharmacy benefit management company contracted by Blue Cross and Blue Shield of Montana (BCBSMT) to provide pharmacy benefit management and related other services. The relationship between BCBSMT and contracting pharmacies is that of independent contractors. Myprime.com is an online resource offered by Prime Therapeutics.

A “value” or “participating” pharmacy has a contract with BCBSMT or BCBSMT’s pharmacy benefit manager (Prime) to provide pharmacy services at a negotiated rate. The terms “value” and “participating” should not be construed as a recommendation, referral or any other statement as to the ability or quality of such pharmacy.

Originally published 3/1/2022; Revised 2022