Save Trips to the Pharmacy: Sync Your Refills
Filling more than one prescription each month can mean several trips to the pharmacy. You may be able to sync your prescriptions and pick them up at the same time, even if the entire supply hasn’t been used yet. You can do this in person at your pharmacy or through home delivery. Here’s how:
1. Refill Limitations let you refill your prescription before you run out. You don’t need any sort of special permission at the pharmacy or through home delivery.
- You can refill at a pharmacy after 75% or more of the 30- or 90-day supply has been used. (That’s 23 days of a 30-day supply or 68 days of a 90-day supply.)
- When using home delivery, you can get a refill after 60% (54 days) or more of the 90-day supply has been used.
- Exception: You can refill migraine medications (called triptans) in person after 100% of the total days (30 days of a 30-day supply) and by mail after 85% of the total days (25 days of a 30-day supply).
2. Early Refills lets you fill prescriptions for special situations, like if you’re going on a long vacation or if your drug is lost or stolen. To refill at a pharmacy or mail home delivery, either the pharmacy staff or the member must call Prime Therapeutics for approval. The number is 800-821-4795.
- You can get a vacation supply of up to 90 days at your pharmacy.
- You’ll pay one copay for every month the supply is filled.
- When using home delivery, you can get a refill of up to 180 days.
- You’ll pay one home delivery copay for every 90-day supply.
- You can get enough medication to last up to the last day of your plan’s coverage.
- Exception: Specialty drugs do not apply.
The following can't be partially filled using the sync program:
- Over-the-counter medications
- Controlled substances
- Prescriptions dispensed in an unbreakable or multi-dose package
Fine Print on Refill Time Frames and Controlled Substances
- Prescriptions can be filled or refilled within one year from the date they are written.
- Prescriptions for a controlled Schedule II can’t be refilled.
- Prescriptions for a controlled Schedule III, IV or V can’t be filled or refilled more than five times within six months after the date they were written.
1A prior authorization is an approval from Florida Blue that is required before certain services will be covered by your health plan. Your doctor will need to submit an authorization request that is approved prior to these services to ensure you have coverage. Exceptions may apply for medical emergencies.
2Certain drugs are not covered unless you try another FDA approved drug first. There may be a lower cost drug that is clinically and cost effective to treat your condition. If an alternate drug is not recommended for you or you had other insurance when you tried the alternate drug, simply ask your doctor to submit an authorization form to request that the drug be covered.
3Some drugs have a maximum quantity that is covered for a given time period. For example, if your doctor prescribes a medication that has a 30-day limit of 9 tablets, your plan covers 9 tablets that month. These safety limits are based on the drug manufacturer’s and Food and Drug Administration’s dosing guidelines.
4Prescription drugs are grouped by Tier. The lower the tier, the lower your cost share.
5This refers to a group of drugs, such as generic, preferred brand, non-preferred brand or therapeutic alternative.