As of January 1, about a third of the members of Blue Cross Blue Shield in Montana can no longer get their prescriptions covered at one of the world’s largest pharmacy chains.  CVS pharmacies haven’t been included in Blue Cross Blue Shield of Montana’s standard pharmacy network after price reimbursement negotiations for certain drugs failed in 2016.

 
Spokesman John Doran of Blue Cross Blue Shield said their main priority is the affordability of care, and said BCBS is trying to do everything possible to minimize charges, but they need to get competitive reimbursement rates.  CVS requested additional higher reimbursement rates for generic prescriptions compared to other pharmacies.

 

The standard BCBS coverage network, which is administered by Prime Therapeutics, includes fully insured groups, small groups and individual retail markets, but not all self-funded commercial groups.  CVS said the decision by BCBS doesn’t affect all members, but does affect plans that were enrolled in through ObamaCare.