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February 7 2025 Blue Cross Blue Shield Commercial Pharmacy Coverage
February 7, 2025: Attention All Providers: Effective February 26, 2025, commercial pharmacy coverage that is received from BCBSM and BCN will be loaded into the CHAMPS Third Party Liability (TPL) Coverage File. TPL will receive commercial pharmacy eligibility updates from BCBSM and BCN daily on business days. Optum RX continues to act as the pharmacy benefit manager (PBM) for Blue Cross of Michigan. Providers are asked to please contact BCBSM, BCN or Optum RX for any questions related to loaded commercial pharmacy coverage. The BCBSM Clinical pharmacy help desk is available at 1-800-437-3803, Optum RX help desk can be reached at 1-800-788-4863
This change will NOT impact BCBSM and BCN commercial medical coverage. TPL will continue to receive commercial medical updates from BCBSM and BCN on a weekly basis.
This change will NOT impact BCBCM and BCN Medicare pharmacy coverage. TPL will continue to receive BCBSM and BCN Medicare pharmacy coverage daily on business days.
This change will NOT impact the majority of Optum RX coverage. TPL will continue to load all updates from Optum RX on a monthly basis unless the records appear on the BCBSM and BCN commercial pharmacy file. Providers may see limited duplicate records between Optum RX and BCBSM RX or BCN RX coverage while the files are transitioning but TPL will correct the duplication during the first week of March 2025.
This change will NOT directly impact anything about the Blue Cross Complete Medicaid Health Plan including enrollment or the TPL file maintained by Blue Cross Complete.