Real-time pharmacy benefit check tool

Starting on Jan. 1, 2027, you can use real-time pharmacy benefits check for all your BCBSND commercial patients to improve the patient experience, decrease their financial strain and improve medication adherence. It can also lead to better provider and patient conversations about treatment plans and reduce your time spent on administrative tasks. To create easier access to a preferred medication database for our members, we’ve partnered with Arrive Health to integrate a real-time benefit check tool for prescribed medications that works within your electronic medical record (EMR) system.

Arrive Health works with many large, national EMR systems (e.g., Epic and Cerner) to provide you quick access to pharmacy benefit checks. With 99% transaction accuracy and over 10 million transactions per month, Arrive Health is a trusted partner to help patients get the right medication at the right price.

How it works

Real-time benefit check information will display when the following criteria are met:

• Patient eligibility has been pulled (workflow varies by EMR system).
• Patient’s pharmacy benefits are covered by a participating pharmacy benefits manager (PBM) (e.g., Prime Therapeutics).
• You’ve entered the national drug code (NDC), preferred pharmacy NPI, quantity and days supply.
  

The tool will present the following patient-specific coverage information:

• Coverage status (covered, not covered, covered with restrictions)
• Coverage alerts (prior authorization required, quantity limit issue, refill too soon, step therapy, etc.)
• Out-of-pocket costs for the patient
• Formulary-driven medication alternatives
• Pharmacy options

Note: This tool is only for medications filled at pharmacies, not those dispensed or administered in the provider’s office.

Get connected

Contact your EMR vendor to find out how to connect your system to the Arrive Health solution.

Learn more about Arrive Health for providers.