On May 15, look for an email from Wes Reohr with a link to this year's producer survey. We want to know how we can best meet your needs and support your clients. Please take a few moments to provide your candid feedback when you get the survey. All responses are anonymous.
Commercial group: Register now for our next webinar
What do biosimilars and gene and cellular therapies mean for your clients?
Capital’s pharmacy strategy focuses on managing medication trends with biologics, biosimilars, cell and gene therapies, and GLP-1s. Join us on Wednesday, May 28th at 10:00 AM for a producer webinar designed to get you up to speed on emerging medical innovations.
Explore more about gene and cellular therapies and biosimilars at THINK, Capital's go-to online journalism for trustworthy health information that empowers business leaders, consultants, and consumers. These articles will get you started:
On August 19 at 10:00 AM, we'll have the last training in our series, Producer Portal: A Comprehensive Demo. You can register for that session now as well.
Please note that the FitOn Health: Maximizing Wellness Opportunities training event for June 3 has been canceled.
Thank you for choosing Capital Blue Cross as your trusted partner. Together, we’re making a difference for Medicare beneficiaries in our communities.
Coming soon: GLP-1 home delivery service through Evernorth EnGuideSM Pharmacy
Evernorth Health Services, the parent company of Express Scripts, is launching Evernorth EnGuideSM Pharmacy, a home delivery pharmacy that will exclusively dispense injectable GLP-1 drugs. Effective June 15, 2025, members with a Capital prescription drug benefit will no longer be able to get home delivery prescriptions for injectable GLP-1s through Express Scripts Pharmacy®.
Prescriptions for members currently getting home delivery injectable GLP-1 drugs through Express Scripts Pharmacy for any indication (including weight loss and diabetes) will be transferred to EnGuide. Home delivery for all other prescription drugs will continue to be available through Express Scripts Pharmacy.
This month we will notify the impacted members by letter to advise them that their home delivery prescription for their injectable GLP-1 drugs will be transferred to EnGuide. Members will be able to use their existing Express Scripts digital tools to manage their home delivery prescriptions for injectable GLP-1 drugs dispensed by EnGuide.
This change will affect members with employer group, Medicare Advantage, IA, or CHIP prescription drug plans if they currently receive an injectable GLP-1 drug through Express Scripts Pharmacy or if they choose home delivery for an injectable GLP-1 prescription in the future.
Evernorth EnGuideSM Pharmacy is a pharmacy that is contracted through Prime Therapeutics LLC to provide mail pharmacy services for GLP-1 injectable drugs to members of Capital Blue Cross. Prime Therapeutics LLC is an independent pharmacy benefit manager.
Between 5 and 100 employees? Consider Small Business ASO
Capital Blue Cross Small Business ASO can be a sensible solution for groups looking to provide their employees with trusted healthcare coverage while protecting their bottom line.
Our Small Business ASO is a level-funded option available to employers covering between five and 100 employees.
The Small Business ASO product portfolio includes health plans similar to the fully insured products, but offers more control, flexibility, and predictability. Groups pay a fixed monthly payment, which covers claims, plan administration, and protection against high-cost claims.
At the end of the plan year, if claims are less than expected costs, groups may receive an invoice credit.
Rates are guaranteed for 12 months, and high-dollar claimants are covered through stop-loss coverage.
Employees have access to high-quality care from top-performing doctors and hospitals.
Access to stop-loss data through Capital’s reports is available to participating groups.
Capital’s Small Business ASO may be a viable option for current fully insured employer groups exploring their options to manage costs. Work with your Capital Sales Executive to negotiate the most competitive rate available by providing rates for comparable plans from other carriers.
Capital appreciates our producer partners and strives to provide efficient and accurate service. When reaching out to Capital by email, phone, or the web, use this guidance to help minimize processing delays and ensure a positive experience for you and your customers.
Always use the most current forms.
Encourage the use of interactive forms to avoid illegible handwriting.
Review to ensure all required fields contain a value.
Always include the group name, group number, and nature of the inquiry in the subject line of any email correspondence.
Use 'General inquiry' in the subject if it is not group specific.
Include the who, what, when, where, and why details in the body of your email.
Refrain from sending the same inquiry to multiple representatives at Capital.
Create a new email with its respective details for an unrelated inquiry. Each new inquiry is assigned a case to research and resolve efficiently. Do not piggyback on a previous email.
Limit duplicate requests by refraining from sending the same inquiry to multiple representatives at Capital.
If you do need to call or send a follow-up inquiry, let us know when and how the original request was submitted. If an inquiry or request is pressing, include Urgent in the subject line. Example of a truly urgent situation is a member needing immediate services.
Established in 1949, Mental Health Awareness Month increases awareness to the importance of mental health and wellness in our lives. Providing comprehensive healthcare plans that include quality mental health coverage supports individuals who may need resources and information.
Capital recognizes the importance of mental wellness and offers members several avenues to seek care when it's needed.
With VirtualCare, members can meet behavioral health professionals including counselors and psychiatrists.
Capital Blue Cross has adopted a team approach to support you, as we collaborate to enhance business relationships, foster your growth through education and incentives, and actively support the communities we serve. The Producer Relations team thanks you for your commitment and hard work. Reach out whenever you need them.
From managers to broker resources and member service information, Capital has you covered. Producers for Individual and Medicare-focused clients, check out your agent guide when you need assistance.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley. Communications issued by Capital Blue Cross in its capacity as administrator of programs.
