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Learn more about your pharmacy benefits

One convenient source for all your pharmacy needs
Our pharmacy benefits manager, Prime Therapeutics, provides a wealth of information and tools to help you get the most from your pharmacy benefits.1 You can learn more about which generics are available, enroll in prescription home delivery service or find a participating pharmacy in your area.

To access the Prime Therapeutics website, sign in to our secure member web portal at HorizonBlue.com/members. Click Doctors & Care from the homepage, then click Pharmacy Services. When you click Prime Pharmacy, you’ll be directed to Prime Therapeutics.

To find medications on our formulary
Our formularies (lists of covered prescription medicines) are available to view online at HorizonBlue.com/members, and are updated regularly as changes are made. You can quickly and easily find out which medicines are included in your plan’s formulary. Sign in to our secure member web portal at HorizonBlue.com/members, click Doctors & Care from the homepage, then click Pharmacy Services. Click Continue to be directed to Prime Therapeutics.

  1. From the top navigation bar, click Medicines and select Find medicines from the dropdown menu.
  2. From the Your Medicines page, scroll down the page to the Helpful documents section and click the drug formulary link, which will display your plan’s formulary guide.
  3. You can also search by medicine name. If you do not have access to a computer, call Pharmacy Member Services at 1-800-370-5088 to have a copy of your plan formulary mailed to you.

Does your medicine have a quantity limit or does it require a prior authorization?

You can find information about how your medicines are covered by signing in to our secure member web portal at HorizonBlue.com/members, clicking Doctors & Care from the homepage, then clicking Pharmacy Services. Click Continue to be directed to Prime Therapeutics.

To find out if a medicine has a quantity limit or requires a prior authorization:

  1. From the top navigation bar, click Medicines and select Find medicines from the dropdown menu.
  2. From the Your Medicines page, scroll down the page to the Helpful documents section and click the drug formulary link.
  3. The drug formulary will indicate which medicines have quantity limits or require a prior authorization.

How your doctor can submit an electronic request for prior authorization (PA), quantity limit (QL) review, or tier exception (TE):

  1. From the top navigation bar, click Forms and select Plan documents from the dropdown menu.
  2. From the Get the forms you need page, scroll down the page to the Prior Authorization/Medical Necessity Determination, Quantity Limits or Tier Exception sections and click the View forms & instructions link.
  3. Click on the Click Here to Complete Your Prior Authorization Electronically link to be directed to NaviNet® for electronic submission. In addition, your doctor can also submit PA, QL or TE requests:

By phone: Call Prime Therapeutics at 1-888-214-1784.

By fax: Use the downloadable forms from the Get the forms you need page and faxing them to Prime Therapeutics at 1-877-897-8808.

By mail: Horizon Blue Cross Blue Shield of New Jersey
c/o Prime Therapeutics LLC,
Clinical Review Department
1305 Corporate Center Drive
Eagan, Minnesota 55121

1Only available to members who have pharmacy benefits from Horizon BCBSNJ.

This article is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.