There are several ways for you to keep updated about product changes, news releases, and other information about Blue Cross Blue Shield of Massachusetts.
Just select a section below to access our most up-to-date information.
Upcoming Prior Authorization Changes for Medications Covered Under the PPO and EPO Medical Benefit
Beginning January 1, 2021, we’re adding Prior Authorization requirements for our members with PPO and EPO plans for certain medications when covered under the medical benefit. Members currently using these medications, and those newly prescribed on or after January 1, 2021, will need an approved authorization to receive coverage. Learn more.
Acceptable Enrollment Formats for New Business One Time Files
When submitting new business enrollment files, it’s important to submit them in the required format to populate your data. This ensures an accurate enrollment experience and avoids delays. Learn more.
Member Months Coverage Report Available for ASC Accounts at No Cost
We’re offering a Member Months Coverage Report to our ASC accounts for the 2020 tax year at no cost. This information is required by the Internal Revenue Service (IRS) under the Affordable Care Act (ACA). Accounts are responsible for sending the report file to their tax vendor, and filing the data with the IRS. Learn more.
Changes to Our Specialty Pharmacy Network for Fertility Medications
Effective August 31, 2020, AcariaHealth™ Fertility will be leaving our specialty pharmacy network for fertility medications. This change applies to plans with the Blue Cross Blue Shield of Massachusetts formulary, and the National Preferred Formulary (NPF). Learn more.
Upcoming Changes to the Blue Cross Blue Shield of Massachusetts Formulary, Effective October 1, 2020
Effective October 1, 2020, we're updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´* plans with a three-tier pharmacy benefit. This update includes the changes that were originally scheduled to go into effect on May 1 and July 1. Learn more.
Upcoming 4th Quarter Changes to the Blue Cross Blue Shield of Massachusetts Formulary
In the fourth quarter of 2020, we're updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´ plans with a three-tier pharmacy benefit. This update includes changes that were originally scheduled to go into effect on May 1 and July 1. Learn more.
Coverage Change for Breast Cancer Risk-Reduction Medications
On October 1, 2020, we’ll begin covering the following generic oral medications in the class of aromatase inhibitors at no additional cost for members when the medications are prescribed to reduce breast cancer risk. Learn more.
Coverage Update for Truvada
On July 1, 2020, we’ll begin covering Truvada, an HIV pre-exposure prophylaxis (PrEP) medication, at no additional cost for members who aren’t currently filling other HIV medications. This change applies to new prescriptions and refills, and to plans with either the Blue Cross Blue Shield of Massachusetts Formulary or National Preferred Formulary. Learn more.
Well Connection Now Offers Psychiatry Care
Well Connection is expanding its behavioral health services to include video-based psychiatry. With this new service, board-certified psychiatrists provide medication management for behavioral health conditions. The psychiatrists can evaluate health, assess the benefits of medications, and prescribe them. Learn more.
Medications That Now Require Prior Authorization, Effective April 1, 2020
Effective April 1, 2020, until further notice, the following medications will have quantity limits for first-time prescriptions for new therapies. Learn more.
July 1st Formulary Changes Temporarily Delayed
In a recent Important Administrative Information (IAI) newsletter we notified you of upcoming formulary (list of covered medications) changes for July 1st that affected medical plans with pharmacy benefits as well as Medex® ́ plans with a three-tier pharmacy benefit. Learn more.
May 1st Formulary Changes Temporarily Delayed
We recently notified you of upcoming formulary (list of covered medications) changes for May 1st that affected medical plans with pharmacy benefits as well as Medex® ́ plans with a three-tier pharmacy benefit. Learn more.
Upcoming Changes to the Blue Cross Blue Shield of Massachusetts Formulary, Effective May 1, 2020 - DELAYED
Beginning May 1, 2020, we're updating our formulary (list of covered medications) for medical plans with pharmacy benefits, as well as Medex®´ plans with a three-tier pharmacy benefit. Learn more.
Changes to Our Specialty Pharmacy Network
Effective March 31, 2020, BriovaRx®' will be leaving our specialty pharmacy network. This change applies to the Blue Cross Blue Shield of Massachusetts formulary, and the National Preferred Formulary (NPF). This does not affect members who have Medicare Advantage with a Part D prescription drug plan; they can continue to use BriovaRx without interruption. Learn more.
How to Help Transition Eligible Employees to a Medicare Plan
You can customize your own Medicare handout by simply adding your company’s logo. This professionally designed flyer will inform both upcoming and late retirees on how to get started, so they can decide which plan is right for them. Learn more.
Changes to Dental Maximum Liability
Effective January 1, 2020, members with a Blue Cross dental plan may only be charged up to the fee schedule amount for additional covered services, according to the in-network dental provider’s contracted fee schedule, even after reaching their benefit maximums. Learn more.
Change to Blue 20/20 Retail Provider Network
Starting February 1, 2020, EyeMed Vision Care®', an independent vision benefits company that administers our Blue 20/20 plans, will no longer contract with Sears Optical, JC Penney Optical, or Stanton Optical. Learn more.
New Online Behavioral Health Resource – Learn to Live
Our new innovative online resource provides support for members who are struggling with depression, insomnia, stress, and anxiety. Learn to Live provides online, self-directed programs and self-assessments based on the principles of Cognitive Behavioral Therapy for employees and their family members (ages 13 or older). Learn more.
No-Cost Flu Vaccine Available for Members
We’re committed to limiting the spread of the flu this season. That’s why there is no cost to the member for the flu vaccine when administered by a participating or preferred health care provider, such as a doctor or nurse practitioner, or at an urgent care center, limited services clinic, or pharmacy-based clinic (like CVS MinuteClinic®’). Learn more.
Weight-Management Program StepIn®´´ Available for Select Self-Funded Accounts
Effective January 1, 2020, StepIn, a new weight-management program, will be included at no additional cost for self-funded accounts with pharmacy benefits who have enrolled in Diabetes Care Value program. Learn more.
Updated List of 2020 Plans Impacted by Member ID Card Distribution Changes
We’ve released a new list of 2020 plans that will be affected by our recent change to the timeline for when we send new member ID cards to Small Group (under 50) accounts that have members in certain plans. Learn more.
Pathway to Savings Now Includes Massachusetts Paid Family and Medical Leave (MA PFML) Products
We’re excited to announce the expansion of our Pathway to Savings program to include MA PFML-compliant products, through our preferred carriers with Indigo InsuranceTM Services. When you choose a MA PFML-compliant plan with one of Indigo’s preferred carriers (USAble, Hartford, AXA, or Symetra) plus one other group line of coverage, you’re eligible to receive .5% off your medical rates for the first year, and .25% off your medical rates for the second year. Learn more.
Members Can Go Paperless
Very soon, members with commercial medical, dental, or Medex®´ plans can choose whether they want to continue receiving claim summary statements (Summary of Health Plan Payments, and Explanation of Benefits) on paper, or go green and view them online using MyBlue. Learn More.
An Easier Way for Members to Manage Their Maintenance Medications
Managing more than one maintenance medication can be complicated and time-consuming. With PillPack, a full-service, in-network pharmacy, members won’t have to worry about going to the pharmacy, organizing their medications, or missing a dose again. That’s because PillPack presorts their medications by day, date, and time, then delivers them to their door in clearly-marked packets, so members know which pills to take and when. PillPack will be available only for fully insured accounts, starting October 22, 2019. Learn more.
Exclusive Savings and Rebates for Blue 20/20 Members
Blue 20/20 members can now take advantage of exclusive savings, discounts, and rebates on eye care products and services. Learn more.
Get Your Employees to Participate in Drug Take Back Day on October 26, 2019
Medications don’t last forever. Over time, their chemical properties change, making them less potent—and even dangerous. Encourage your employees to go through their medicine cabinets and check for any expired or unwanted medications—this includes everything from aspirin to prescription medications. Learn more.
January 2020: Updates to Our Pharmacy Formulary
Beginning January 1, 2020, we're updating our list of covered medications for medical plans with pharmacy benefits, as well as Medex®' plans with a three-tier pharmacy benefit. Learn more.
Enhancements to Our Find a Doctor & Estimate Costs Tool
Find a Doctor and Estimate Costs tool is now available within MyBlue, making it even easier for members to take control of their health care. Learn more.
Enhancements to the MyBlue App
Throughout 2019, we’ve been making several enhancements to the MyBlue App that offers our members a better user experience, improved performance, and full integration with the MyBlue website. Learn more.
Health Plan Updates for 2020
Effective January 1, 2020, and upon renewal, we’re making changes to our health plans to ensure that we continue to meet the ongoing requirements of health care reform, while providing the high-quality, affordable coverage you and your employees expect from Blue Cross. Learn more.
Introducing ScreenRx®´ for Self-Insured Accounts
To help our members manage chronic conditions and stay on track with their medications, we’re offering ScreenRx to self-insured accounts, starting January 1, 2020. Learn more.
Introducing RationalMed®´ for Self-Insured Accounts
Effective January 1, 2020, we’re adding RationalMed, a new medication safety solution, as a core benefit to our pharmacy program for self-insured accounts. Learn more.
Smart90®´ Now Included in Core Benefits for Self-Insured Accounts with Pharmacy Benefits
Starting January 1, 2020, upon renewal, self-insured accounts with pharmacy benefits will include the Smart90 program, which allows members to get a 90-day supply of certain maintenance medications through the mail order pharmacy, or from the more than 9,800 CVS PharmacyTM retail locations nationwide. Learn more.
Blue Cross Blue Shield of Massachusetts Surpassed 2018 Medical Loss Ratio Requirements
In 2018, Blue Cross Blue Shield of Massachusetts exceeded the state and federal medical loss ratio (MLR) requirements for all market segments. As a result, we don’t need to issue account rebates for 2018. Learn more.
Upcoming Changes to Member ID Card Distribution
Beginning November 1, 2019, we’re changing the timeline for when we send new Member ID cards to members in certain plans for Small Group (under 50) accounts. Learn more.
New Federal Medicare Mandate (MACRA)
A federal law will change Medicare Supplement plan options for those who are newly eligible for Medicare on or after January 1, 2020. As of that date, we’ll no longer offer our Medex®´Bronze plan to people who are newly eligible for Medicare. However, benefits for our current Medex Bronze, Choice, or Core plan members won’t change. Learn more.
New Self-Service Reporting Tool for Accounts with 100+ Employees
We’re introducing a new self-service claims analytics tool later this year called BlueInsights. It will be available to all employers with 100+ employees. At that time, we’ll also retire the current ReportBlue system. Learn more.
Member Months Coverage Report Available for ASC Accounts at No Cost
We’re offering a Member Months Coverage Report to our ASC accounts for the 2019 tax year at no cost. This service must be requested prior to November 1, 2019. Learn more.
Updates to Our Dental Blue® Total Health Solution
Effective September 1, 2019 for new and renewing accounts, we’re expanding our list of chronic conditions that qualify members for Enhanced Dental Benefits. Learn more.
Important Employer Surveys
In July, some accounts received at least one of two surveys in the mail from us that require a timely response: the Patient Protection and Affordable Care Act (PPACA) survey, and the federal Medicare Secondary Payer (MSP) survey. These surveys help us determine if an account is eligible to receive a rebate for 2019 (to be issued in 2020), and ensure that employees are enrolled correctly and their claims are properly adjudicated. Learn more about these surveys, medical loss ratios, and national health care reform.
Changes to Specialty Pharmacies and Updated Medication List
Effective July 1, 2019, we’ll implement changes to our retail specialty pharmacy network and to the medications these pharmacies can fill. Learn more. Learn more.
Introducing the Enhanced Diabetes Eye Care Benefit
To help members with type 1 and 2 diabetes better manage their care, we have added an enhanced diabetes eye care benefit to our Blue 20/20 Exam Only and Exam Plus plans, effective July 1, 2019. Learn more.
Introducing Our New Medication Lookup Tool
With our new and improved Medication Lookup tool, members, prospective members, and providers can easily find important information about any medication, including coverage, strength, and additional requirements. Learn more.
We’re Expanding Our Behavioral Health Coverage for Children and Adolescents
Beginning July 1, 2019, Blue Cross Blue Shield of Massachusetts will cover the following services for members under 19 years old:
Read the full article for more information.
Support for Members Affected by Midwest Flooding
In response to the recent Missouri River flooding, we are expediting access to care for members who live in affected areas of Iowa and Nebraska. Learn more.
Safely Dispose of Expired or Unwanted Drugs on April 27, 2019
Medications don’t last forever. Over time, their chemical properties change, making them less potent—and even dangerous. Learn more.
Expanded Coverage for Osteoporosis Screening in Women
As of June 1, 2019, we’re expanding our commercial plan coverage to provide osteoporosis screenings for women under 65 years old who are at increased risk. Learn more.
Enrollment Kits and Benefits@Blue Changes for Small Group Accounts
Starting January 14, 2019, electronic enrollment kits (eKits) and our customized Benefits@Blue websites will be generated automatically for small group accounts in the Inside Sales and Small Groups - 25–50 segments. Learn more.
Flu Shot Program Changes
Our greatest priorities at Blue Cross Blue Shield of Massachusetts (“Blue Cross”) are to assist our members in accessing affordable, quality care, and to provide them with the best consumer experience possible. In support of these priorities, we regularly review our programs and services to ensure that they are still meeting the needs of our account partners and members.
With that in mind, we are announcing a change to our offering. Learn more.
Updates to Our Prior Authorization Requirements
Beginning July 1, 2019, our prior authorization requirements for the medications listed below are changing for members with our HMO, Access Blue, and Blue Choice® plans. Read More.
Upcoming Changes to Our Pharmacy Program
Beginning July 1, 2019, we’re making changes to our list of covered medications for medical plans with pharmacy benefits, as well as Medex®´plans with a three-tier pharmacy benefit. As part of these updates, certain medications may no longer be covered, may be excluded from pharmacy benefit coverage, may switch cost tiers, or might require prior authorization. Read the full article for a complete list of affected medications.
New Orthodontic Payment Schedule
For all comprehensive orthodontic claims, with dates of service on or after January 1, 2019, payment will now be processed on a monthly schedule. This is a change from the previous arrangement, when these benefits were administered in two payments, six months apart. Learn more.
Updates to Our Employer Website
We want to let you know that we’ve added several improvements to our website for Employers. These updates will enhance the user experience and enable additional capabilities in the future. Learn more.
We’re Partnering with Virgin Pulse®´´ to Encourage Employee Health and Well-being
In 2018, Blue Cross and Virgin Pulse created and launched ahealthyme®´ Rewards, a fully-funded turnkey wellness program, as well as Healthy Together, a team-oriented fitness challenge concept. Both initiatives have been successful, and the two companies will build on their partnership with an expanded offering in January 2019. Learn more.
With New Website Design, Promoting ahealthyme Rewards Is Even Easier
Now all the marketing materials you need to spread the word about your new wellness program can be viewed and accessed—right from our newly-designed website. Learn more.
New Health Education and Engagement Services Through Wellness Concepts
We’re excited to announce that beginning January 1, 2019, our health education and engagement services will expand significantly to incorporate a wide range of new topics and events. Learn more.
No-Cost Flu Vaccine Available for Members
For the 2018-2019 flu season, we cover the cost of the flu shot (for all members ages six months and older), and now the nasal spray flu vaccine, commonly known as FluMist (for specific populations), when a member gets the vaccine from a health care professional, a pharmacy-based clinic (like CVS MinuteClinic®’), or another qualified facility. Coverage depends on an individual member’s plan type and the nature of the care received. Members should consult with their health care professional before receiving a flu vaccine. Learn more.
Help for Members Affected by California Wildfires
As deadly wildfires continue to burn in California, Blue Cross Blue Shield is committed to providing support to all of our members who live in affected areas. Learn more.
Safely Dispose of Expired or Unwanted Drugs on October 27, 2018
Medications don't last forever. Over time, their chemical properties change, making them less potent—and even dangerous. Learn more.
Help for Members Affected by Hurricane Michael
Blue Cross Blue Shield of Massachusetts is saddened by the impact of Hurricane Florence. We're committed to providing support to all members who live in affected areas of Florida. Learn more.
ACA Member Months Coverage Report Available for ASC Accounts
Our Administrative Services Contract (ASC) accounts will gain access to a tax reporting service, which follows the Affordable Care Act (ACA) guidelines. As part of our continued efforts to provide service enhancements, we will once again give you the choice to have us run your Member Months Coverage Report at no cost. Learn more.
Prepayment Inpatient Claim Review
As previously communicated in a June IAI, we've partnered with Equian, a nationally known payment integrity vendor, to help continue to manage costs and improve the accuracy of claim payments. Learn more.
Expanded Fitness and Weight-Loss Reimbursement Benefits
Effective upon renewal starting January 1, 2019, we'll expand the definition of qualifying programs for our Fitness and Weight-Loss Reimbursements. This will provide more options for members who use these types of programs and reward them for a broader range of healthy behaviors. Learn more.
Upcoming Changes to Our Pharmacy Program
Beginning January 1, 2019, we're making changes to our list of covered medications for medical plans with pharmacy benefits, as well as Medex®' plans with a three-tier pharmacy benefit. As part of these updates, certain medications will no longer be covered, switch tiers, have a new dosing limit, require prior authorization, or have a change in cost. Learn more.
Help for Members Affected by Hurricane Florence
Blue Cross Blue Shield of Massachusetts is saddened by the impact of Hurricane Florence. We're committed to providing support to all members who live in affected areas of the Carolinas and Virginia. To help expedite access to care, we're adjusting the following policies for members in impacted areas. Learn more.
We Surpassed Medical Loss Ratio Requirements for 2017
For the reporting year of 2017, Blue Cross Blue Shield of Massachusetts won't issue rebates, as our loss ratio exceeded state and federal requirements for all market segments. Learn more.
New Electronic Benefits Enrollment Process for Businesses with 10-150 Enrolled Subscribers
We're pleased to offer a new electronic enrollment support solution for businesses with 10-150 enrolled subscribers (20+ eligible employees) to help simplify benefits administration. As a first-in-market solution, we've partnered with five leading technology platforms and three channel partners to offer a better education, shopping, and administration experience. Learn more.
Introducing Prepayment Inpatient Claim Review
To help manage costs and improve the accuracy of claim payments, we've partnered with Equian, a nationally-known payment integrity vendor, to review certain inpatient claims prior to payment. Effective April 1, 2018 for fully insured accounts and January 1, 2019 on renewal for ASC accounts, inpatient claims that meet identified criteria will be reviewed prior to payment to ensure accurate reimbursement. Learn more.
Introducing Well Connection, Our New Doctor Video Visit Tool for Members
Beginning April 2, 2018, we'll be launching Well Connection, a new digital tool that lets members have live doctor video visits using their smartphone, tablet, or computer. Well Connection is replacing the telehealth platform that our members currently use. This updated service will have a refreshed look and feel, as well as a new app and website. Well Connection will use a new platform that can be seamlessly upgraded to enhance the member experience. Learn more.
Introducing the Future High-Cost Member Report for ASC Accounts
We're pleased to introduce the Future High-Cost Member report for ASC accounts, which uses new predictive modeling logic to better identify members likely to incur high claims. Learn more.
New Massachusetts State Mandate - Contraceptives
On Monday November 20, 2017, Governor Baker signed into law the contraceptive ACCESS bill (An Act advancing contraceptive coverage and economic security in our state). This bill is effective May 20, 2018, and mandates coverage for the following contraceptive methods and services for females, with no cost sharing. Learn more.
Your Employees Are Getting Access to More Dentists
Beginning January 1, 2018, Dental Blue® members will be able to get service from nearly 122,000 dentists, and 300,000 provider locations across the country through our Dental Blue National Network. This new network is one of the largest in the country, and is nearly twice the size of our current national network. Learn more.
Limiting Spread of the Flu Virus
We make it easy for members and their families to get vaccinated. This flu season, we're offering a range of provider, workplace, and pharmacy-based vaccine locations. Coverage depends on the plan type and the nature of the care received. Learn more.
Low-Cost Generic Drug Benefit
Did you know that if your plan includes a mail service pharmacy benefit, covered employees can get a 90-day supply of select generic medications for only $9 when filled through Express Scripts?