Choosing a pharmacy network that works

AdobeStock_426469238.jpeg

Much like a health care network, pharmacy benefits offer network options too. Ranging from broad access to cost-controlled, there’s a choice that meets the needs of both you and your employees.

What is a pharmacy network?

A pharmacy network is a group of pharmacies contracted with a health insurance carrier to provide members coverage for certain products and services (like prescriptions and durable medical equipment), usually at a lower cost than out-of-network pharmacies.

For Wellmark Blue Cross and Blue Shield members, finding an in-network pharmacy is only a click away. The Find a Pharmacy tool uses a few details to find the best pharmacy options.

Wellmark's pharmacy network options

Wellmark has multiple pharmacy network options to choose from when building a benefits package for your employees.

• The National network includes more than 68,000 major chains and community pharmacies throughout the U.S. and more than 98 percent of pharmacies in Iowa and South Dakota.
• The Advanced Choice network covers 60,000 pharmacies (the 8,000 excluded are mostly redundancies — like having two pharmacies on the same block, for example).
• The Maintenance Choice^® network provides an option for 90-day supply maintenance medications — or those that an employee takes regularly for chronic conditions – and can be delivered by mail or picked up. It’s easy, convenient and offers additional cost savings.

Preferred vendors for specialty pharmacy

According to a report from CVS Health, specialty drugs made up 54 percent of all prescription drug spend in the U.S. in 2021. This is why Wellmark provides specialty network options that not only meet your business needs, but your employees' too.

• An open specialty drug network allows members to fill specialty drugs at any specialty pharmacy.
• Wellmark's specialty drug program is managed under both pharmacy and medical benefits to better coordinate care and manage costs. It directs volume into two preferred vendors (Hy-Vee Pharmacy Solutions and CVS Specialty) for greater savings. This network also features varying cost-share designs to direct usage toward drugs that are safe, effective and reasonably priced.
• The CVS Exclusive specialty drug program offers specialty rates, and you can even implement a copay card program for additional savings from a manufacturer, if it's available.

Managing your pharmacy network doesn’t mean limiting access. Adjustments like these allow your pharmacy benefits to remain valuable while still focusing on future sustainability.

myWellmark^® delivers need-to-know pharmacy information

Once your employees register and log into myWellmark, their specific benefits and coverage information will customize the available tools. For pharmacy coverage specifically, they will be able to see how much a drug will cost based on their benefits and drug list, find an in-network pharmacy, and so much more.

Learn more about the different ways you can personalize your pharmacy benefits program to best serve your employees and your organization’s bottom line:

• 3 ways to structure your formulary
• Specialty drug prices giving you sticker shock?
• Checking the digital Wellmark Drug List

Questions? Contact your authorized Wellmark representative.