Benefits
Search this tool to access ACA Member's benefits
What is the Benefit Viewer (BV)?
ACA Members Pharmacy Benefit Manager (PBM)
Who is Prime?
GLP-1 medications are approved for weight loss for ACA Members
False. (Florida Blue health plans do NOT cover GLP-1 medications or any medications prescribed for weight loss. Weight loss services are NOT a covered benefit.)
Health Plan's approved medications are found here
What is a Drug Formulary or Medication Guide?
Where Members are referred to for Specialty Rx
Who is Accredo or CVS Caremark?
Prescriptions for weight loss may be covered with a Prior Authorization for ACA members.
False. (Florida Blue health plans do NOT cover GLP-1 medications or any medications prescribed for weight loss. Weight loss services are NOT a covered benefit.)
Location where ACA Member's approved drug list is located
What is Prescription or Pharmacy Coverage in Benefit Viewer?
Vendor that will process Medical Pharmacy prescription for ACA Members
Who is CVS Caremark?
Medical Pharmacy benefits are found in Prescription Benefits section
False. (Medical Pharmacy is found/covered under Medical benefits.)
Self-administered injectable is covered under this benefit
What is Specialty Medicine or Pharmacy?
Group members are transferred to which vendor
Trick question! Check the Prescription or Pharmacy Benefits section in Benefit Viewer! While most group members may use Prime, many groups may utilize a different vendor.
When in doubt about prescription benefits, transfer the call to Prime.
False. (Refer to available resources: Search K360 article, Pharmacy Inquiries, for additional information; request assistance from Senior.)
Provider administered medication is covered under this benefit
What is Medical Pharmacy?
Self-administered injectable medication is covered under this benefit
What is Specialty Medicine or Pharmacy?
Prime has more information to better assist members.
False. (In most cases, advocates are better equipped to assist members; refer to Benefit Viewer, K360, Care Connect, and your Seniors for guidance when needed.)